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BMC Medical Research Methodology
Published in: BMC Medical Research Methodology 1/2014

Open Access 01-12-2014 | Technical advance

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

Authors: Carlos Crespo, Antonio Monleon, Walter Díaz, Martín Ríos

Published in: BMC Medical Research Methodology | Issue 1/2014

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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.
Appendix
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Metadata
Title
Comparative efficiency research (COMER): meta-analysis of cost-effectiveness studies
Authors
Carlos Crespo
Antonio Monleon
Walter Díaz
Martín Ríos
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2014
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/1471-2288-14-139

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