Updated Recommendations for Cost-effectiveness Studies

Abstract

To the Editor Cost-effectiveness is a relatively new discipline, for which guidelines continue to be developed and refined. The article by Dr Sanders and colleagues 1 offered updated reference cases and perspectives as well as a checklist in an attempt to improve standards and minimize bias in published studies.There is evidence that cost-effectiveness studies sponsored by pharmaceutical companies are more likely to report positive cost-effective results. 2 As a means to address this and other potential biases, we agree with the authors' recommendations to require a true societal health care perspective and include an impact inventory.The authors included in the checklist that an analytic plan be described within the article. We propose that not only should the analytic plan be described in the methods section, but it should also be made public prior to the analysis. This would hold cost-effectiveness studies to the same standards as systematic reviews and randomized clinical trials, both of which have guidelines that require registration of studies that detail the methods and outcomes prior to execution. 3,4 Registration of systematic reviews and randomized clinical trials have been incorporated into guidelines in an effort to address the problems of multiple comparisons and selective outcomes reporting.Requiring cost-effectiveness investigators to commit to a prespecified analytic plan would promote transparency and differentiation between a priori and post hoc analyses. This differentiation would encourage investigators to develop robust analytic plans prior to performing their analysis and would limit the risk of manipulation of the model until the desired result is obtained, a problem similar to that found in multiple comparisons. The additional transparency would allow readers to understand more thoroughly how the investigators arrived at their results and see what modifications they made along the way.Cost-effectiveness methodology has developed significantly during the last few decades and these new recommendations should help advance it even further. An added recommendation of trial registration would be another means of guarding against bias in a field just coming of age.

Exploring the use of economic evidence to inform investment in disease prevention – a qualitative study

“…Conversely, more work can be done to encourage decision makers to look beyond their organisational perspectives and to take on board evidence of societal and sector‐wide impacts. This may include promoting recent initiatives in the health economics literature such as the use of cost consequences analyses of ‘social impact inventories’, which represent evaluation techniques that take multi‐dimensional social outcomes into account 38,39 …”