Comparative efficiency research (COMER): meta-analysis of cost-effectiveness studies

Abstract

BackgroundThe aim of this study was to create a new meta-analysis method for cost-effectiveness studies using comparative efficiency research (COMER).MethodsWe built a new score named total incremental net benefit (TINB), with inverse variance weighting of incremental net benefits (INB). This permits determination of whether an alternative is cost-effective, given a specific threshold (TINB > 0 test). Before validation of the model, the structure of dependence between costs and quality-adjusted life years (QoL) was analysed using copula distributions. The goodness-of-fit of a Spanish prospective observational study (n = 498) was analysed using the Independent, Gaussian, T, Gumbel, Clayton, Frank and Placket copulas. Validation was carried out by simulating a copula distribution with log-normal distribution for costs and gamma distribution for disutilities. Hypothetical cohorts were created by varying the sample size (n: 15–500) and assuming three scenarios (1-cost-effective; 2-non-cost-effective; 3-dominant). The COMER result was compared to the theoretical result according to the incremental cost-effectiveness ratio (ICER) and the INB, assuming a margin of error of 2,000 and 500 monetary units, respectively.ResultsThe Frank copula with positive dependence (−0.4279) showed a goodness-of-fit sufficient to represent costs and QoL (p-values 0.524 and 0.808). The theoretical INB was within the 95% confidence interval of the TINB, based on 15 individuals with a probability > 80% for scenarios 1 and 2, and > 90% for scenario 3. The TINB > 0 test with 15 individuals showed p-values of 0.0105 (SD: 0.0411) for scenario 1, 0.613 (SD: 0.265) for scenario 2 and < 0.0001 for scenario 3.ConclusionsCOMER is a valid tool for combining cost-effectiveness studies and may be of use to health decision makers.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2288-14-139) contains supplementary material, which is available to authorized users.

Systematic Review and Meta-Analysis of Cost-effectiveness of Rotavirus Vaccine in Low-Income and Lower-Middle-Income Countries

“…However, the systematic review by Thiboonboon et al [11] mainly focused on methodological differences between economic studies conducted in high-income countries (HIC) and in LMICs, whereas the systematic review by Kotirum et al [3] provided only qualitative evidence without distinguishing LICs and LMICs. Neither review provided quantitative evidence of cost-effectiveness measured by the incremental cost-effectiveness ratio (ICER), the ratio of the cost difference between new and standard treatments to the clinical effectiveness difference between these treatments [12], which can be more useful for policy makers in LICs and LMICs.…”

“…Therefore, an incremental net benefit (INB) has been developed, calculated by multiplying WTP times the difference in effectiveness subtracted from the difference in costs [14]. It is distributed normally based on the central limit theorem [12]. The new treatment is said to be cost-effective if the INB is positive [14, 15].…”

Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies

“…We used INB instead of ICER as the economic effect measure because of limitations of the ICER. 80 For instance, a negative ICER may indicate a lower cost compared with higher effectiveness of intervention or higher cost, along with lower effectiveness of intervention, thus introducing ambiguity in interpretation 16 81 ; in contrast, positive and negative INBs directly indicate cost-effectiveness and non-cost-effectiveness, which is the information required by policy makers. 82 83 Such information helps provide evidence informed policy for decision makers from both resource-rich and resource-poor countries.…”

“…Meta-analysis of economic evaluation studies was first developed by Crespo et al , 16 and our research teams have recently further developed their methods to cover all aspects of meta-analysis. 9 10 The incremental net benefit (INB) is calculated by multiplying willingness to pay (WTP) (per unit) and change in effectiveness (in units) and then subtracting the difference in costs; this estimate of INB is then pooled across studies, taking into account within-study and between-study variations.…”

The Covariance Adjustment Approaches for Combining Incomparable Cox Regressions Caused by Unbalanced Covariates Adjustment: A Multivariate Meta-Analysis Study

“…An IPD procedure requires individual data collection, whereas APD is based on summarized data that is extracted from published reports. While APD results are not as desirable as IPD, the majority of meta-analysis work relies on APD due to time availability and financial restriction [ 4 – 7 ].…”