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)

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 > School of Health & 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