Acknowledging patient heterogeneity in economic evaluation

Grutters, J.P.C., Sculpher, M., Briggs, A.H. , Severens, J.L., Candel, M.J., Stahl, J.E., de Ruysscher, D., Boer, A., Ramaekers, B.L.T. and Joore, M.A. (2013) Acknowledging patient heterogeneity in economic evaluation. PharmacoEconomics, 31(2), pp. 111-123. (doi:10.1007/s40273-012-0015-4)

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Abstract

<p>Background and Objective - Patient heterogeneity is the part of variability that can be explained by certain patient characteristics (e.g. age, disease stage). Population reimbursement decisions that acknowledge patient heterogeneity could potentially save money and increase population health. To date, however, economic evaluations pay only limited attention to patient heterogeneity. The objective of the present paper is to provide a comprehensive overview of the current knowledge regarding patient heterogeneity within economic evaluation of healthcare programmes.</p> <p>Methods - A systematic literature review was performed to identify methodological papers on the topic of patient heterogeneity in economic evaluation. Data were obtained using a keyword search of the PubMed database and manual searches. Handbooks were also included. Relevant data were extracted regarding potential sources of patient heterogeneity, in which of the input parameters of an economic evaluation these occur, methods to acknowledge patient heterogeneity and specific concerns associated with this acknowledgement.</p> <p>Results - A total of 20 articles and five handbooks were included. The relevant sources of patient heterogeneity (demographics, preferences and clinical characteristics) and the input parameters where they occurred (baseline risk, treatment effect, health state utility and resource utilization) were combined in a framework. Methods were derived for the design, analysis and presentation phases of an economic evaluation. Concerns related mainly to the danger of false-positive results and equity issues.</p> <p>Conclusion - By systematically reviewing current knowledge regarding patient heterogeneity within economic evaluations of healthcare programmes, we provide guidance for future economic evaluations. Guidance is provided on which sources of patient heterogeneity to consider, how to acknowledge them in economic evaluation and potential concerns. The improved acknowledgement of patient heterogeneity in future economic evaluations may well improve the efficiency of healthcare.</p>

Item Type:Articles
Additional Information:This is a non-final version of an article published in final form in Grutters, J.P.C., Sculpher, M., Briggs, A.H., Severens, J.L., Candel, M.J., Stahl, J.E., de Ruysscher, D., Boer, A., Ramaekers, B.L.T., and Joore, M.A. (2013) Acknowledging patient heterogeneity in economic evaluation. PharmacoEconomics, 31 (2). pp. 111-123. ISSN 1170-7690
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Briggs, Professor Andrew and Sculpher, Mr Mark
Authors: Grutters, J.P.C., Sculpher, M., Briggs, A.H., Severens, J.L., Candel, M.J., Stahl, J.E., de Ruysscher, D., Boer, A., Ramaekers, B.L.T., and Joore, M.A.
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 > School of Medicine, Dentistry & Nursing
Journal Name:PharmacoEconomics
Publisher:Springer
ISSN:1170-7690
Published Online:04 January 2013

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