Adherence to the iDSI reference case among published cost-per-DALY averted studies

Abstract

Background The iDSI reference case, originally published in 2014, aims to improve the quality and comparability of cost-effectiveness analyses (CEA). This study assesses whether the development of the guideline is associated with an improvement in methodological and reporting practices for CEAs using disability-adjusted life-years (DALYs). Methods We analyzed the Tufts Medical Center Global Health CEA Registry to identify cost-per-DALY averted studies published from 2011 to 2017. Among each of 11 principles in the iDSI reference case, we translated all methodological specifications and reporting standards into a series of binary questions (satisfied or not satisfied) and awarded articles one point for each item satisfied. We then calculated methodological and reporting adherence scores separately as a percentage of total possible points, measured as normalized adherence score (0% = no adherence; 100% = full adherence). Using the year 2014 as the dissemination period, we conducted a pre-post analysis. We also conducted sensitivity analyses using: 1) optional criteria in scoring, 2) alternate dissemination period (2014–2015), and 3) alternative comparator classification. Results Articles averaged 60% adherence to methodological specifications and 74% adherence to reporting standards. While methodological adherence scores did not significantly improve (59% pre-2014 vs. 60% post-2014, p = 0.53), reporting adherence scores increased slightly over time (72% pre-2014 vs. 75% post-2014, p<0.01). Overall, reporting adherence scores exceeded methodological adherence scores (74% vs. 60%, p<0.001). Articles seldom addressed budget impact (9% reporting, 10% methodological) or equity (7% reporting, 7% methodological). Conclusions The iDSI reference case has substantial potential to serve as a useful resource for researchers and policy-makers in global health settings, but greater effort to promote adherence and awareness is needed to achieve its potential.

Examining Equity Effects of Health Interventions in Cost-Effectiveness Analysis: A Systematic Review

“…Third, we excluded other methods of examining equity effects in CEAs (eg, MCDA), which can also be used to ensure that equity is considered in decision making. Finally, although 64% of included studies met the complete CHEERS checklist, which is within the range that previous systematic reviews on other topics have reported, [96][97][98] the checklist itself does not evaluate the quality of CEAs and only how they are reported. 99…”

Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia

“…This framework is in development and will be based on similar initiatives internationally. 22 The populations of interest are average-risk Australians and subgroups relevant to the modelled evaluations. For each evaluation, several primary outcomes are considered, including the following: ► Health benefits, for example, reduction in lifetime risk of CRC incidence and mortality.…”

Improving the quality of economic evaluation in health in low- and middle-income countries: where are we now?

“…In this way, the iDSI reference case aimed to achieve broad applicability but local relevance to decision maker's needs. A recent review [4] of the formal take-up of the iDSI reference case in journal publications reporting cost per disability-adjusted life year found limited explicit citation of the iDSI reference case; however, this may reflect the iDSI focus on the direct policy process and supporting analytics, much of which may not achieve publication. It also demonstrates that quality improvement initiatives require dedicated action to encourage uptake from decision makers, who, in the case of global health are often-times development partners and are not always the same as the beneficiaries of improved decisions, which such methodological standards as the reference case are supposed to inform.…”