Increasing the generalizability of economic evaluations: Recommendations for the design, analysis, and reporting of studies

Abstract

Objectives:Health technology assessment (HTA) is increasingly an international activity, and HTA agencies collaborate to avoid unnecessary duplication of effort. However, the sharing of the results from HTAs raises questions about their generalizability; namely, are the results of an HTA undertaken in one country relevant to another?Methods:This study presents recommendations for increasing the generalizability of economic evaluations. They represent an important component of HTAs and are commonly thought to have limited generalizability.Results:Recommendations are given for studies using patient-level data (i.e., evaluations conducted alongside clinical trials) and for studies using decision analytic modeling.Conclusions:If implemented, the recommendations would increase the value for investments in HTA.

The Role of Review and Synthesis Methods in Decision Models

“…Estimates of resource use, costs, and outcome values are sensitive to features of local contexts, such as prices, preferences and the configuration of service delivery (see also, inter alia, Chapters 3, 4, 8 and 13). 17,56,57 This may limit the generalisability and transferability of such estimates across settings. Therefore, selection of the best available sources of locally applicable data for a specific context is ( subject to availability), arguably, likely to be preferable to (adjusted) estimates based on data collected in other settings and to pooled estimates derived using a synthesis of (adjusted) data collected from several studies conducted in different settings (see also, inter alia, Chapters 3, 4 and 9).…”

“…16 In a CBA, measures of the outcomes of compared interventions are valued monetarily based on estimates of people's willingness to pay for these outcomes, which is calculated using stated preference methods (contingent valuation), revealed preference methods or the human capital approach. 17,18 Examples of the use of monetary valuation techniques to undertake a CBA can be found in the evaluation of criminal justice interventions. 19,20 Donaldson and colleagues identified a number of approaches to the use of systematic reviews to inform economic evaluations of health care interventions.…”

Generalisability, Transferability, Complexity and Relevance

“…20,31 The checklists are intended to be useful for decision makers using economic evaluations, but may also be useful for those planning or undertaking economic evaluations. If the principles suggested in the complex interventions, with only two contributions by health economists on the implications for assessing their cost-effectiveness.…”

The time for cost-effectiveness in the new European Union member states: the development and role of health economics and technology assessment in the mirror of the Hungarian experience

“…Recently, several authors argued that it is time for a common standard for cost-effectiveness in Europe [1,2]. Jönsson [3] pointed out that today, 30 years after the first steps were taken to introduce economic evaluation as an instrument in health policy in Europe, it is time to go further.…”