What Do International Pharmacoeconomic Guidelines Say about Economic Data Transferability?

Abstract

A growing number of jurisdictions are using guidelines for the economic evaluation of pharmaceuticals. The recommendations in existing guidelines regarding the transferability of clinical and economic data are quite diverse. There is a case for standardization in dealing with transferability issues. One important step would be to update guidelines more frequently.

A Cost Analysis of Salbutamol Administration by Metered-Dose Inhalers with Spacers versus Nebulization for Patients with Wheeze in the Pediatric Emergency Department: Evidence from Observational Data in Nova Scotia

“…2 While cross-regional extrapolation of epidemiological outcomes is commonly accepted in health economic evaluations, clinical outcomes such as LOS and hospitalization rates may be less generalizable because of jurisdictional variations in socioeconomic status, practice variability, and supply of health care resources. [13][14][15] Our objective was to conduct an economic evaluation of both salbutamol inhalation methods based on local, hospitalspecific patient-level outcome and cost data.…”

Contributions from the systematic review of economic evaluations: the case of childhood hepatitis A vaccination in Brazil

“…Measures of clinical events can be misleading if there are differences in the underlying epidemiological estimates. The "guidelines" recommend the use of specific country data 40 . In the absence of local data, it is recommended that data from countries with similar endemicity be used.…”

“…Differences in clinical practices, payment systems, and incentives are generally cited as the principal reasons for variation in the use of resources between one location and another. When there are no local data and it becomes necessary to transfer data from elsewhere, an expert panel is recommended for reviewing the data and evaluating whether the treatment patterns are similar, in order to produce more relevant estimates for the local context 40 . The Brazilian case requires obtaining the pattern of care practiced in local health services in order to determine the resources (medical consultations, hospitalizations, tests, drugs, etc.)…”

“…The guidelines are very strict and do not allow transferring these data under any circumstances. Cost unit estimates must be specific to the context being evaluated, due to differences in absolute and relative prices between countries 40 . Thus, in the Brazilian case, direct medical costs for outpatient and inpatient treatment of hepatitis A, hepatic failure with or without subsequent liver transplant, and post-transplant follow-up, as well as the costs of the vaccine, must necessarily use local data.…”

Evidências econômicas de intervenções em saúde sob a perspectiva do sistema único de saúde: por que e para que produzi-las e utilizá-las?

“…No que diz respeito às avaliações econô-micas, eles sustentam que é preciso separar, inicialmente, aquelas baseadas em dados dos indivíduos daquelas que utilizaram modelos de decisão, pois cada tipo irá requerer dados e métodos diferentes para a adaptação das análises ao contexto local. No geral, observaram que: i) as estimativas sobre os efeitos dos tratamentos são aceitas como mais transferíveis do que os dados econômicos; ii) a principal deficiência dos manuais reside em não distinguir o efeito do tratamento e a linha de base (por exemplo, incidência da doença ou desfecho da doença na população) quando tratam da transferibilidade dos dados clínicos, visto que esses dois elementos diferem muito quanto ao nível de generalização; iii) aparentemente os países são mais flexíveis quanto à avaliação de transferibilidade quando dados locais estão menos disponí-veis; iv) muitas das diferenças dos manuais entre localidades parecem estar relacionadas à data de publicação do manual e ao nível de maturidade local para a realização de avaliações econômicas; e, por fim, v) embora a transferibilidade seja tra-J Bras Econ Saúde 2017;9(2): 229-36 tada como importante, poucos métodos foram propostos para lidar com a questão (Barbieri et al, 2010).…”