Varenicline is a dominant option (more effective at a lower cost) compared with all other smoking cessation treatments when the timeframe is the life span of the patient. Varenicline is cost-effective even when shorter timeframes are considered (20 years or more), with an estimated incremental cost per QALY far bellow any threshold commonly accepted in our environment.
Objectives: The objective of this study was to evaluate the methodological characteristics of cost-effectiveness evaluations carried out in Spain since 1990 which include LYG as an outcome to measure the incremental cost-effectiveness ratio. Methods: A systematic review of published studies was conducted describing their characteristics and methodological quality. We analyze the cost per LYG results in relation with a commonly-accepted Spanish cost effectiveness threshold and the possible relation with the cost per quality adjusted life year (QALY) gained when they were both calculated for the same economic evaluation. Results: A total of 62 economic evaluations fulfilled the selection criteria, 24 of them including the cost per QALY gained result as well. The methodological quality of the studies was good (55%) or very good (26%). A total of 124 cost per LYG results were obtained with a mean ratio of 49,529€ and a median of 11,490€ (standard deviation of 183,080). Since 2003, a commonly-accepted Spanish threshold has been referenced by 66% of studies. A significant correlation was found between the cost per LYG and cost per QALY gained results (0.89 Spearman-Rho, 0.91 Pearson). Conclusions: There is an increasing interest for economic healthcare evaluations in Spain and the quality of the studies is also improving. Although a commonly-accepted threshold exists, further information is needed for decision making as well as to identify the relationship between the costs per LYG and per QALY gained.Response to Reviewers: We decided to give response to specific reviewer and editor comments in this box and uploading the corresponding attachment file as well.
In this second article of a series of three, we will discuss using the Metaplan technique on controversial issues of health outcomes in economic evaluation of health care interventions. The four-discussion areas focus on: choice of health outcomes measures, where any outcome measure is superior to another; extrapolation and transferability of health outcomes measures, which should not be assumed the results of an EEIS of one country to another without making certain adjustments; appropriate instruments to measure quality of life in Spain, where the EQ-5D was indicated as convenient due to its widespread international use; and, indirect comparisons, where the combination of both comparisons, direct and indirect, it would be advisable if the test for indirect estimates is consistent and has been validated. Finally, research lines to try to overcome the identified discrepancies were identified in each of these areas, some of those are: doing studies of correlation between scores of specific and generic instruments measuring quality of life; update or create a database of economic evaluations in Spain; estimating utilities for the Spanish population by existing generic and specific instruments; or, establish a common way to show the results of a meta-analysis network.
The development of the economic evaluation of health care interventions has become a support tool in making decisions on pricing and reimbursement of new health interventions. The increasingly extensive application of these techniques has led to the identification of particular situations in which, for various reasons, it may be reasonable to take into account special considerations when applying the general principles of economic evaluation. In this article, which closes a series of three, we will discuss, using the Metaplan technique, about the economic evaluation of health interventions in special situations such as rare diseases and end of life treatments, as well as consideration of externalities in assessments, finally pointing out some research areas to solve the main problems identified in these fields.
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