Assessing generalisability by location in trial-based cost-effectiveness analysis: the use of multilevel models

Manca, A., Rice, N., Sculpher, M.J. and Briggs, A.H. (2005) Assessing generalisability by location in trial-based cost-effectiveness analysis: the use of multilevel models. Health Economics, 14(5), pp. 471-485. (doi: 10.1002/hec.914)

Abstract

Cost-effectiveness analysis (CEA) in health care is increasingly conducted alongside multicentre and multinational randomised controlled clinical trials (RCTs). The increased use of stochastic CEA is designed to account for between-patient sampling variability in cost-effectiveness data assuming that observations are independently distributed. However, between-location variability in cost-effectiveness may result if there is a hierarchical structure in the data; that is, if there is correlation in costs and outcomes between patients recruited in particular locations. This may be expected in multi-location trials given that centres and countries often differ in factors such as clinical practice, patient case-mix and the unit costs of delivering health care. A failure to acknowledge this feature may lead to misleading conclusions in a trial-based economic study. Multilevel modelling (MLM) is an analytical framework that can be used to handle hierarchical cost-effectiveness data. Using data from a recently conducted economic analysis, this paper shows how multilevel modelling can be used to obtain (a) more appropriate estimates of the population average incremental cost-effectiveness and associated standard errors compared to standard stochastic CEA; and (b) location-specific estimates of incremental cost-effectiveness which can be used to explore appropriately the variability between centres/countries of the cost-effectiveness results.

• Item Type: Articles
• Keywords: generalisability; trial-based cost-effectiveness analysis; multilevel modelling; multinational and multicentre RCTs
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Briggs, Professor Andrew
• Authors: Manca, A., Rice, N., Sculpher, M.J., and Briggs, A.H.
• 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: Health Economics
• Publisher: John Wiley and Sons
• ISSN: 1057-9230