Industry involvement and baseline assumptions of cost-effectiveness analyses: diagnostic accuracy of the Papanicolaou test

Abstract

G iven the substantial impact of costeffectiveness analyses on public health policies, it is important to safeguard their robustness. However, most published costeffectiveness analyses report favourable incremental cost-effectiveness ratios, and industryfunded analyses are more likely to report desirable ratios.1 Some journals discourage cost-effectiveness analysis studies that have been conducted or funded by sponsors of the examined interventions.2 Examples exist in which cost-effectiveness analysis studies on the same topic have reached different conclusions depending on who funded them.3 Yet the mechanism for such discrepancies in seemingly rigorous quantitative analyses is unclear.The process of cost-effectiveness analysis involves making assumptions about the main parameters of interest that enter calculations. Baseline values and plausible ranges are specified. When baseline assumptions vary across different cost-effectiveness analyses, results may diverge considerably. We evaluated the baseline assumptions of the diagnostic accuracy of a widely used and studied screening test, 4 the Papanicolaou (Pap) test (i.e., conventional cervical cytology) in cost-effectiveness analysis studies. The diagnostic accuracy of the Pap test has been studied extensively, 5-7 and assumptions about its accuracy are pivotal for any cost-effectiveness analysis related to screening for and prevention of cervical cancer. Moreover, alternative approaches, such as DNA testing for human papilloma virus (HPV) or HPV vaccines, are quite expensive. New tests may get favourable cost-effectiveness ratios against the Pap test if the performance of the Pap test is assumed to be suboptimal.We therefore examined whether cost-effectiveness analysis studies involving screening for and prevention of cervical cancer assumed different diagnostic performance estimates for the Pap test and whether differences reflected sponsorrelated biases. Industry involvement and baseline assumptions of cost-effectiveness analyses: diagnostic accuracy of the Papanicolaou testNikolaos P. Polyzos MD, Antonis Valachis MD, Davide Mauri MD, John P.A. Ioannidis MD Research CMAJ Background: Industry involvement has been associated with more favourable cost-effectiveness ratios in cost-effective ness analyses, but the mechanisms for this association are unclear. We evaluated whether the assumed accuracy of the Papanicolaou (Pap) test was correlated with the features of cost-effectiveness analysis studies.

When Are Statins Cost-Effective in Cardiovascular Prevention? A Systematic Review of Sponsorship Bias and Conclusions in Economic Evaluations of Statins

“…These results are consistent with other studies assessing the relationship between the source of funding and the cost-effectiveness findings, specifically for oncologic drugs [29–33], neuropsychiatric drugs [34–36], venous thromboembolism pharmacologic prevention [37], drug-eluting stents [38], bisphosphonates for osteoporosis treatment [39], Pap tests for cervical cancer diagnosis [40]. They are also consistent with the CEAs submitted by manufacturers to health technology assessment agencies [5,6], and/or reviews selecting general cost-effectiveness studies [4,7,41,42].…”

A Systematic Review and Methodological Evaluation of Published Cost-Effectiveness Analyses of Aromatase Inhibitors versus Tamoxifen in Early Stage Breast Cancer

“…[60], [61] For example, Polyzos et al demonstrated that industry-sponsored CEAs assessing cervical cancer screening were more likely to exclude data sources presenting favourable results for existing technologies. [60], [61] We can consider our results in light of approaches for addressing parameter uncertainty, structural uncertainty, and methodological uncertainty in CEA modeling. Despite significant parameter uncertainty about the true value of the relative risk of breast cancer recurrence for AIs compared to tamoxifen, 44% of analyses we identified did not vary this critical parameter in even one-way sensitivity analysis.…”

Strategies to Reach Marginalized Women for Cervical Cancer Screening: A Qualitative Study of Stakeholder Perspectives

“…Researcher respondents were particularly adamant that Canadian cervical cancer screening programs should shift towards primary hpv testing because the increase in sensitivity has the greatest impact on population health and health system spending, in the era of hpv vaccination 6,37 . Though not mentioned by interview respondents, some research questions whether this improvement might be exaggerated in the literature because of industry sponsorship of research 38 , which suggests that the shift may not be as "urgent" as some authors convey. In Canada, the Ontario government recently allocated funding for hpv testing in primary cervical cancer screening in their 2017 budget.…”