A Bayesian approach to aid in formulary decision making: incorporating institution-specific cost-effectiveness data with clinical trial results

Reed, S.D., Dillingham, P.W., Briggs, A.H. , Veestra, D.L. and Sullivan, S.D. (2003) A Bayesian approach to aid in formulary decision making: incorporating institution-specific cost-effectiveness data with clinical trial results. Medical Decision Making, 23(3), pp. 252-264. (doi:10.1177/0272989X03023003007)

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Publisher's URL: http://dx.doi.org/10.1177/0272989X03023003007

Abstract

Pharmacy and therapeutics committees commonly cite a lack of generalizability as a reason for not incorporating cost-effectiveness information into decision making. To address this concern, many committees undertake site-specific economic evaluations, which are often limited by small sample sizes and nonrandomized designs. We show how 2 complementary approaches were used to minimize these limitations in an economic evaluation of abciximab at 1 institution. Using a propensity score methodology, we selected patients who did not receive abciximab for the comparison cohort. Then, we adopted a Bayesian, hierarchical, random-effects model to integrate site-specific and clinical trial data. We applied the posterior distributions of effectiveness with local cost data in a traditional decision-analytic model. In 74% of the simulations, abciximab was cost-effective at 1 institution at the $50,000 per life year saved threshold, assuming a 50:50 split of patients undergoing coronary stenting and angioplasty. Among patients undergoing coronary stenting, the cost-effectiveness ratio of the addition of abciximab was at or below the $50,000 per life year saved threshold in 66.0% of the simulations.

Item Type:Articles
Keywords:Bayesian analysis; cost-effectiveness; decision making; formulary decision making ;Monte Carlo simulation
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Briggs, Professor Andrew
Authors: Reed, S.D., Dillingham, P.W., Briggs, A.H., Veestra, D.L., and Sullivan, S.D.
Subjects:R Medicine > RA Public aspects of medicine
H Social Sciences > HJ Public Finance
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences
Journal Name:Medical Decision Making
Publisher:SAGE Publications
ISSN:0272-989X
Copyright Holders:Copyright © 2003 SAGE
First Published:First published in Medical Decision Making 23(3):252-264
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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