Economic Evaluation alongside Multinational Studies: A Systematic Review of Empirical Studies

Abstract

Purpose of the studyThis study seeks to explore methods for conducting economic evaluations alongside multinational trials by conducting a systematic review of the methods used in practice and the challenges that are typically faced by the researchers who conducted the economic evaluations.MethodsA review was conducted for the period 2002 to 2012, with potentially relevant articles identified by searching the Medline, Embase and NHS EED databases. Studies were included if they were full economic evaluations conducted alongside a multinational trial.ResultsA total of 44 studies out of a possible 2667 met the inclusion criteria. Methods used for the analyses varied between studies, indicating a lack of consensus on how economic evaluation alongside multinational studies should be carried out. The most common challenge appeared to be related to addressing differences between countries, which potentially hinders the generalisability and transferability of results. Other challenges reported included inadequate sample sizes and choosing cost-effectiveness thresholds.ConclusionsIt is recommended that additional guidelines be developed to aid researchers in this area and that these be based on an understanding of the challenges associated with multinational trials and the strengths and limitations of alternative approaches. Guidelines should focus on ensuring that results will aid decision makers in their individual countries.

Economic evaluation of treatments for patients with localized prostate cancer in Europe: a systematic review

“…An important issue related to the generalizability of study findings is the cost-effectiveness threshold, which represents society’s willingness-to-pay for an additional unit of benefit [ 26 ]. Studies from UK showed a very consistent pattern regarding this threshold: they considered NICE’s thresholds of £20,000–£30,000 per QALY gained [ 22 , 32 , 33 , 41 ].…”

“…Most of the economic evaluations were conducted in the US [ 23 – 26 ], yet differences in health systems across countries limit their results’ generalizability. Although there are also important differences within European countries, they share some major principles (such as a mainly publicly funded and almost universal coverage) far away from the insurance-based US health care system.…”

Peer support for people with severe mental illness versus usual care in high-, middle- and low-income countries: study protocol for a pragmatic multicentre randomised controlled trial (UPSIDES-RCT)

“…All costs will be converted into international dollars/USD ($) using purchasing power parities (PPP) [39]. Quality-adjusted life years (QALYs) will be estimated using the EQ-5D 3L at t 0 -t 3 which is used in most multinational cost-utility studies [40] and available in the languages of all study sites. As country-specific population-based value sets are not available for most study sites, QALYs will be estimated on the basis of the European EQ-5D visual analogue scale (VAS) for all countries [41].…”

An Educational Review About Using Cost Data for the Purpose of Cost-Effectiveness Analysis

“…There is no clear consensus on how best to conduct economic evaluations in the context of multinational trials. The methods used for conducting an economic evaluation in the context of a multinational trial have been considered by three different literature reviews by Reinhold et al [111] and Oppong et al [112], with Vemer and Rutten-van Mölken [113] focussing specifically on statistical methods used to enable transferability between country settings. Manca et al [114] have critically appraised the methodologies used for CEA as part of multinational trials, and a general discussion about the transportability of comparative cost effectiveness between countries has been discussed by Briggs [115], with 'good practice' guidance suggested by Drummond et al [116].…”