Abstract
BackgroundThe aim of this study was to create a new meta-analysis method for cost-effectiveness studies using comparative efficiency research (COMER).MethodsWe built a new score named total incremental net benefit (TINB), with inverse variance weighting of incremental net benefits (INB). This permits determination of whether an alternative is cost-effective, given a specific threshold (TINB > 0 test). Before validation of the model, the structure of dependence between costs and quality-adjusted life years (QoL) was analysed using copula distributions. The goodness-of-fit of a Spanish prospective observational study (n = 498) was analysed using the Independent, Gaussian, T, Gumbel, Clayton, Frank and Placket copulas. Validation was carried out by simulating a copula distribution with log-normal distribution for costs and gamma distribution for disutilities. Hypothetical cohorts were created by varying the sample size (n: 15–500) and assuming three scenarios (1-cost-effective; 2-non-cost-effective; 3-dominant). The COMER result was compared to the theoretical result according to the incremental cost-effectiveness ratio (ICER) and the INB, assuming a margin of error of 2,000 and 500 monetary units, respectively.ResultsThe Frank copula with positive dependence (−0.4279) showed a goodness-of-fit sufficient to represent costs and QoL (p-values 0.524 and 0.808). The theoretical INB was within the 95% confidence interval of the TINB, based on 15 individuals with a probability > 80% for scenarios 1 and 2, and > 90% for scenario 3. The TINB > 0 test with 15 individuals showed p-values of 0.0105 (SD: 0.0411) for scenario 1, 0.613 (SD: 0.265) for scenario 2 and < 0.0001 for scenario 3.ConclusionsCOMER is a valid tool for combining cost-effectiveness studies and may be of use to health decision makers.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2288-14-139) contains supplementary material, which is available to authorized users.
Highlights
The aim of this study was to create a new meta-analysis method for cost-effectiveness studies using comparative efficiency research (COMER)
We suggest that the method for meta-analyses of cost-effectiveness analyses (CEA) proposed here, which is known as COMparative Efficiency Research (COMER), and which groups together studies on a specific topic, may represent reality more closely and allow more evidence-based decision making
Cost-effectiveness studies compare the efficiency of therapies evaluated using the incremental cost-effectiveness ratio (ICER), where the numerator is the difference between the estimated cost of the new treatment and that of the reference treatment and the denominator estimates the effectiveness gained by the new treatment compared with the reference treatment [1]
Summary
The aim of this study was to create a new meta-analysis method for cost-effectiveness studies using comparative efficiency research (COMER). Economic evaluation of health technologies (EEHT) has become a first-order health policy decision making tool at the European level. We suggest that the method for meta-analyses of CEA proposed here, which is known as COMparative Efficiency Research (COMER), and which groups together studies on a specific topic, may represent reality more closely and allow more evidence-based decision making. As for any meta-analysis, the validity of the COMER method will depend on systematic review of the types of studies supporting the data, the populations assessed and the variability or levels of consistency between centres and/or studies
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