Abstract
This paper asks the question ‘are cost-effectiveness league tables a good way to provide information to decision makers about the value of new healthcare interventions?’ League tables that rank alternative healthcare interventions based on their incremental cost-effectiveness ratios (ICERs) are seen by economists as a valuable tool to inform decision makers about the allocation of scarce healthcare resources. However, league tables frequently compare ICERs from studies that have computed these ratios using different methods and assumptions including choice of comparator, choice of discount rate, time horizon, and population subgroup. The methodological differences among studies may influence the ranking of the studies and therefore decisions made using the league table. In addition, league tables generally do not include measures of the uncertainty of the cost-effectiveness estimates. In this paper, a reference case approach is proposed for the computation of the incremental cost-effectiveness ratio and an expanded set of measures is proposed for inclusion in the league table. In addition, a central repository for reference case expanded league tables is suggested so that decision makers can use them more effectively and more consistently.
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References
Mason J. Cost-per-QALY leagues tables: their role in pharmacoeconomic analysis. Pharmacoeconomics 1994; 5 (6): 472–81
Williams AH. Economics of coronary artery bypass grafting. BMJ 1985; 291: 326–9
Torrance GW, Zipursky A. Cost-effectiveness of antepartum prevention of Rh immunization. Clin Perinatol 1984; 11: 267–81
Graham JD, Corso PS, Morris JM, et al. Evaluating the costeffectiveness of clinical and public health measures. Annu Rev Public Health 1998; 19: 125–52
Pinkerton SD, Johnson-Masotti AP, Holtgrave DR, et al. Using cost-effectiveness league tables to compare interventions to prevent sexual transmission of HIV. AIDS 2001; 15: 17–28
Lindholm L, Hallgren C, Boman K, et al. Cost-effectiveness analysis with defined budget: how to distribute resources for the prevention of cardiovascular disease. Health Policy 1999; 48: 155–70
Moore RD, Bartlett JG. Combination antiretroviral therapy in HIV infection: an economic perspective. Pharmacoeconomics 1996; 10 (2): 109–13
George B, Harris A, Mitchell A. Cost-effectiveness analysis and the consistency of decision making: evidence from pharmaceutical reimbursement in Australia (1991 to 1996). Pharmacoeconomics 2001; 19 (11): 1103–9
Mason J, Drummond M, Torrance G. Some guidelines on the use of cost effectiveness league tables. BMJ 1993; 306: 570–2
Drummond M, Torrance G, Mason J. Cost-effectiveness league tables: more harm than good? Soc Sci Med 1993; 37: 33–40
Harris A, Buxton M, O’Brien B, et al. Using economic evidence in reimbursement decisions for health technologies: experience in 4 countries. Expert Rev Pharmacoeconomics Outcomes Res 2001; 1: 7–12
Gold MR, Siegal JA, Russell LB, et al., editors. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996
Pharoah P, Hollingworth W. Cost effectiveness of lowering cholesterol concentration with statins in patients with and without pre-existing coronary heart disease: life table method applied to health authority population. BMJ 1996; 312:1443-8
Briggs A, Gray A. Using cost effectiveness information. BMJ 2000; 320: 246–8
Jacobson T, Schein J, Williamson A, et al. Maximizing the cost-effectiveness of lipid-lowering therapy. Arch Intern Med 1998; 158:1977–89
Chapman R, Stone P, Sandberg E, et al. A comprehensive league table of cost-utility ratios and a sub-table of “panelworthy” studies. Med Decis Making 2000; 20: 451–67
Simes R, Glasziou P. Meta-analysis and quality of evidence in the economic evaluation of drug trials. Pharmacoeconomics 1992; 1 (4): 282–92
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17: 1–12
Murray CJL, Evans DB, Acharya A, et al. Development of WHO guidelines on generalised cost-effectiveness analysis. Health Econ 2000; 9: 235–51
Sendi P, Gafni A, Birch S. Opportunity costs and uncertainty in the economic evaluation of health care interventions. Health Econ 2002; 11: 23–32
Karlsson G, Johannesson M. The decision rules of cost-effectiveness analysis. Pharmacoeconomics 1996; 9 (2): 113–20
Bala M, Mauskopf J. The estimation and use of confidence intervals in economic analysis. Drug Inf J 1999; 33: 841–8
Hutubessy R, Baltussen R, Barendregt J, et al. Stochastic league tables: communicating cost-effectiveness results to decisionmakers. Health Economics 2001 Jul; 10 (5): 473–7
O’Brien B, Sculpher M. Building uncertainty into cost-effectiveness rankings: portfolio risk-return tradeoffs and implications for decision rules. Med Care 2000; 38: 460–8
Laupacis A, Feeny D, Detsky A, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evidence. CMAJ 1992; 146: 473–81
Rutten F, van Busschbach J. How to define a basic package of health services for a tax funded or social insurance based health care system. Eur J Health Econ 2001; 2: 45–6
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No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript. The manuscript was based on an issues panel presentation by the authors at the Fourth Annual European Congress of ISPOR, November 2001.
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Mauskopf, J., Rutten, F. & Schonfeld, W. Cost-effectiveness league tables. Pharmacoeconomic 21, 991–1000 (2003). https://doi.org/10.2165/00019053-200321140-00001
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DOI: https://doi.org/10.2165/00019053-200321140-00001