Factors Limiting Subgroup Analysis in Cost-Effectiveness Analysis and a Call for Transparency

Shields, Gemma; Wilberforce, Mark; Clarkson, Paul; Farragher, Tracey; Verma, Arpana; Davies, Linda

doi:10.1007/s40273-021-01108-4

Cited by 8 publications

(4 citation statements)

References 38 publications

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“…This trend of aggregate reporting limits the possibilities for comprehensive economic evaluations of implementations. Shield et al reported on this in their paper on factors limiting cost-effectiveness analysis [ 79 ], and Fukuda and Imanaka reported the same challenge in their assessment of the transparency of cost estimates in economic evaluations of patient safety programmes [ 80 ]. Thus, the incomplete reporting and quantification of cost components limit the availability of the needed raw material for sophisticated but useful health economics research, as well as evidence synthesis.…”

Section: Discussionmentioning

confidence: 99%

Availability of published evidence on coverage, cost components, and funding support for digitalisation of infectious disease surveillance in Africa, 2003–2022: a systematic review

Kaburi,

Harries,

Hauri

et al. 2024

BMC Public Health

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Background The implementation of digital disease surveillance systems at national levels in Africa have been challenged by many factors. These include user applicability, utility of IT features but also stable financial support. Funding closely intertwines with implementations in terms of geographical reach, disease focus, and sustainability. However, the practice of evidence sharing on geographical and disease coverage, costs, and funding sources for improving the implementation of these systems on the continent is unclear. Objectives To analyse the key characteristics and availability of evidence for implementing digital infectious disease surveillance systems in Africa namely their disease focus, geographical reach, cost reporting, and external funding support. Methods We conducted a systematic review of peer-reviewed and grey literature for the period 2003 to 2022 (PROSPERO registration number: CRD42022300849). We searched five databases (PubMed, MEDLINE over Ovid, EMBASE, Web of Science, and Google Scholar) and websites of WHO, Africa CDC, and public health institutes of African countries. We mapped the distribution of projects by country; identified reported implementation cost components; categorised the availability of data on cost components; and identified supporting funding institutions outside Africa. Results A total of 29 reports from 2,033 search results were eligible for analysis. We identified 27 projects implemented in 13 countries, across 32 sites. Of these, 24 (75%) were pilot projects with a median duration of 16 months, (IQR: 5–40). Of the 27 projects, 5 (19%) were implemented for HIV/AIDs and tuberculosis, 4 (15%) for malaria, 4 (15%) for all notifiable diseases, and 4 (15%) for One Health. We identified 17 cost components across the 29 reports. Of these, 11 (38%) reported quantified costs for start-up capital, 10 (34%) for health personnel compensation, 9 (31%) for training and capacity building, 8 (28%) for software maintenance, and 7(24%) for surveillance data transmission. Of 65 counts of external funding sources, 35 (54%) were governmental agencies, 15 (23%) foundations, and 7 (11%) UN agencies. Conclusions The evidence on costing data for the digitalisation of surveillance and outbreak response in the published literature is sparse in quantity, limited in detail, and without a standardised reporting format. Most initial direct project costs are substantially donor dependent, short lived, and thus unsustainable.

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Section: Discussionmentioning

confidence: 99%

Availability of published evidence on coverage, cost components, and funding support for digitalisation of infectious disease surveillance in Africa, 2003–2022: a systematic review

Kaburi,

Harries,

Hauri

et al. 2024

BMC Public Health

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“…8 , 9 Therefore, an intervention that appeared to be cost-effective for one patient subgroup might not be cost-effective for another. 53 It is recommended that potential patient subgroups should be considered early in the process of economic evaluation. Of the nine included studies, only two conducted subgroup analysis.…”

Section: Discussionmentioning

confidence: 99%

“…However, none of the included studies reported on their consideration of patient subgroups, such as potential subgroups considered, the rationale for conducting or not conducting subgroup analysis and any limitations. 53 …”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of physical activity interventions for people with schizophrenia or bipolar disorder: systematic review

2023

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BackgroundClinical guidelines recommend providing physical activity interventions (PAIs) to people with schizophrenia or bipolar disorder for weight management. However, the cost-effectiveness of PAIs is unknown.AimsTo evaluate the availability and methodological quality of economic evaluations of PAIs for people with schizophrenia or bipolar disorder.MethodFour databases (MEDLINE, Embase, PsycInfo and Scopus) were searched on 5 July 2022. Based on the retrieved studies, forward and backward citation searches were conducted. Two reviewers independently selected studies for inclusion. Study quality was assessed using the Drummond checklist. Review results were presented using narrative synthesis.ResultsFourteen articles reporting nine studies were included. All included studies assessed PAIs within a multicomponent lifestyle intervention. Mixed findings were reported on the cost-effectiveness of multicomponent lifestyle intervention: three studies reported it as cost-effective; four studies reported it as not cost-effective; and two studies did not conclude whether it was cost-effective or not. Very limited evidence suggests that certain patient subgroups might be more likely to benefit from multicomponent lifestyle interventions with a PAI component: men; individuals with comorbid type 2 diabetes; and individuals who have been psychiatric hospital in-patients for ≥1 year. The quality of included studies ranged from moderate to high.ConclusionsThe current economic evidence suggests that not all modalities of multicomponent lifestyle intervention including a PAI component are cost-effective for people with schizophrenia or bipolar disorder; and not all people with schizophrenia or bipolar disorder would benefit equally from the intervention. Future research is urgently needed to identify the cost-effective modality of PAI for different patient subgroups.

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“…This phenomenon also re ects a considerable degree of uncertainty for an economist, further complicated by the relatively small number of patients undergoing nutritional interventions in our and other studies [31,32]. Despite the positive results of ICER, we are faced with the decision on whether to implement these interventions based on ensuring compliance [33].…”

Section: Alternative Treatmentmentioning

confidence: 93%

Limits of outpatient palliative oncological care: A cost analysis of nutritional interventions.

Molnarova,

Maresova,

Rezny

et al. 2024

Preprint

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Background The purpose of palliative medicine is to achieve and maintain the best possible quality of life for patients and support their families, relatives, and friends. Therefore, we conducted a case-control observational retrospective study evaluating the economic burden of nutritional intervention during ambulatory palliative oncology care, aiming to implement the obtained data to the quality of healthcare. Methods A comparison of total expenses per patient was made between the three groups of patients, i.e., Group A – 256 patients with systematic nutritional intervention during 2020-22, Group B − 1393 patients treated during 2020-22, and Group C – 940 patients without systematic nutritional intervention during in 2017-19. The expense analysis was performed using mixed methods monitoring nutritional intervention, i.e. medical records, laboratory tests, and insurance bills from the palliative oncology clinic. The collected data included four categories (direct and indirect cost): nutritional supplements, other medical expenses, requested care, and other care. The qualitative costs and benefits analyses were done within the CBA method framework, i.e. online interviews of relevant stakeholders who were involved in the process of nutritional measures. Results The Mann–Whitney U-test showed significant (P < 0.001) differences between the tested groups, with the lowest median of total expenses in Group B (2,921 CZK) and the highest in Group A (16,692 CZK), demonstrating a significant reduction in total expenses. The same was observed in the comparison between Group C (4,923 CZK) and Group B (2,921 CZK) during 2020-22. Conclusion The present study proves that nutritional intervention, and the related modifications in palliative treatment, benefit the patients and reduce the overall costs of healthcare.

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Factors Limiting Subgroup Analysis in Cost-Effectiveness Analysis and a Call for Transparency

Cited by 8 publications

References 38 publications

Availability of published evidence on coverage, cost components, and funding support for digitalisation of infectious disease surveillance in Africa, 2003–2022: a systematic review

Availability of published evidence on coverage, cost components, and funding support for digitalisation of infectious disease surveillance in Africa, 2003–2022: a systematic review

Cost-effectiveness analysis of physical activity interventions for people with schizophrenia or bipolar disorder: systematic review

Limits of outpatient palliative oncological care: A cost analysis of nutritional interventions.

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