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

ABSTRACT: Background: The aim of this study was to create a new meta-analysis method for cost-effectiveness studies using comparative efficiency research (COMER). Methods: We 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. Results: The 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. Conclusions: COMER is a valid tool for combining cost-effectiveness studies and may be of use to health decision makers.

• Autores: Díaz, Walter; Ríos, Martín; Monleon, Antonio; Crespo, Carlos
• Tipo de recurso: Review article
• Fecha de publicación: 2014
• Institución: Universidad de Antioquia
• Repositorio: Repositorio UdeA
• Idioma: spa
• OAI Identifier: oai:bibliotecadigital.udea.edu.co:10495/39617
• Acceso en línea: https://hdl.handle.net/10495/39617
• Palabra clave: Investigación sobre la Eficacia Comparativa; Comparative Effectiveness Research; Análisis de Costo-Efectividad; Cost-Effectiveness Analysis; Interpretación Estadística de Datos; Data Interpretation, Statistical; Metaanálisis como Asunto; Meta-Analysis as Topic; Estudios Prospectivos; Prospective Studies; Años de Vida Ajustados por Calidad de Vida; Quality-Adjusted Life Years; https://id.nlm.nih.gov/mesh/D057186; https://id.nlm.nih.gov/mesh/D000094703; https://id.nlm.nih.gov/mesh/D003627; https://id.nlm.nih.gov/mesh/D015201; https://id.nlm.nih.gov/mesh/D011446; https://id.nlm.nih.gov/mesh/D019057
• Rights: openAccess
• License: https://creativecommons.org/licenses/by/4.0/