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PharmacoEconomics

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01-11-2006 | Conference Paper

‘Lost in Translation’

Accounting for Between-Country Differences in the Analysis of Multinational Cost-Effectiveness Data

Authors: Dr Andrea Manca, Andrew R. Willan

Published in: PharmacoEconomics | Issue 11/2006

Abstract

Cost-effectiveness analysis has gained status over the last 15 years as an important tool for assisting resource allocation decisions in a budget-limited environment such as healthcare. Randomised (multicentre) multinational controlled trials are often the main vehicle for collecting primary patient-level information on resource use, cost and clinical effectiveness associated with alternative treatment strategies. However, trial-wide cost effectiveness results may not be directly applicable to any one of the countries that participate in a multinational trial, requiring some form of additional modelling to customise the results to the country of interest.

This article proposes an algorithm to assist with the choice of the appropriate analytical strategy when facing the task of adapting the study results from one country to another. The algorithm considers different scenarios characterised by: (a) whether the country of interest participated in the trial; and (b) whether individual patient-level data (IPD) from the trial are available.

The analytical options available range from the use of regression-based techniques to the application of decision-analytic models. Decision models are typically used when the evidence base is available exclusively in summary format whereas regression-based methods are used mainly when the country of interest actively recruited patients into the trial and there is access to IPD (or at least country-specific summary data).

Whichever method is used to reflect between-country variability in cost-effectiveness data, it is important to be transparent regarding the assumptions made in the analysis and (where possible) assess their impact on the study results.

The issue is the mismatch between the source of the data and the location of the decision maker.Thus,it could be argued that we should be referring to the ‘jurisdiction of interest ’,where the term ‘jurisdiction’ encompasses both within-country (e.g.regions,provinces)and country-level decision makers.

Note that v _j and u _j are assumed to follow a bivariate Normal distribution,to reflect the fact that each country ’s mean cost in the control arm is correlated to the differential mean cost.In the analysis of the clinical data,this assumption would reflect the fact that the baseline events are correlated with the relative treatment effects.

This type of bias occurs when the relationship of relative treatment effect and patient averages across countries is not the same as the relationship for patients within countries.It may happen,for instance,that at a trial level a given treatment is clinically more effective (and cost effective)in younger patients.However,using average age in each country as a covariate for subgroup analysis will show no relationship between mean age and relative treatment effect if the distribution of the covariate age is similar across countries.[85,86]

An analysis similar to what would be carried out if one were to explore the generalisability of the absolute treatment effect identified in trials across a range of clinically defined patient subgroups where the same separation of baseline risks and relative treatment effect can be employed.

There are various dimensions in the extrapolation problem. This can relate to beyond-trial extrapolation (that is from short-term to long-term outcomes), from intermediate endpoints to final outcomes, and from intermediate endpoints or final clinical outcomes to health-related QOL.

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Title: ‘Lost in Translation’
Accounting for Between-Country Differences in the Analysis of Multinational Cost-Effectiveness Data
Authors: Dr Andrea Manca
Andrew R. Willan
Publication date: 01-11-2006
Publisher: Springer International Publishing
Published in: PharmacoEconomics / Issue 11/2006
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI: https://doi.org/10.2165/00019053-200624110-00007

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‘Lost in Translation’

Accounting for Between-Country Differences in the Analysis of Multinational Cost-Effectiveness Data

Abstract

Keynote webinar | Spotlight on medication adherence

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Abstract

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Other articles of this Issue 11/2006

Using Value of Information Analysis to Prioritise Health Research

Building Bridges Between Academic Research and Policy Formulation

Information Created to Evade Reality (ICER)

Economic Evaluations in the Canadian Common Drug Review

Economic Evaluation in the US

Pharmacoeconomics and Pharmacoepidemiology