ArticleMedical decision making : an international journal of the Society for Medical Decision Making2016
Mind the Gap! A Multilevel Analysis of Factors Related to Variation in Published Cost-Effectiveness Estimates within and between Countries.
Article in Medical decision making : an international journal of the Society for Medical Decision Making, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 5 syntheses or guidelines pooled it, 13 citations in OpenAlex.
- Economic evaluations of colorectal cancer screening: A systematic review and quality assessment.Clinics (Sao Paulo, Brazil) · 2023Pooled it
- A Systematic Review of Methods and Study Quality of Economic Evaluations for the Treatment of Schizophrenia.Frontiers in public health · 2021Pooled it
- Heterogeneity of cost estimates in health economic evaluation research. A systematic review of stress urinary incontinence studies.International urogynecology journal · 2019Pooled it
- Disparities in model-based cost-effectiveness analyses of tuberculosis diagnosis: A systematic review.PloS one · 2018Pooled it
- Economic Evaluations Comparing a Trial of Labor with an Elective Repeat Cesarean Delivery: A Systematic Review.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2017Pooled it
- Cost-Effectiveness Analysis of Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computed Tomography (PET/CT) for the Primary Staging of Prostate Cancer in Australia.PharmacoEconomics · 2022Trial
- Exploring the Generalizability of Foreign Cost-Effectiveness Analysis to Spain Using Data From a Scoping Review of Multinational Studies.PharmacoEconomics · 2026Article
- Prioritising allocation of donor human breast milk amongst very low birthweight infants in middle-income countries.Maternal & child nutrition · 2018Article
- Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review.Global health research and policy · 2018Review
- Cost-effectiveness of antiplatelet drugs after percutaneous coronary intervention.European heart journal. Quality of care & clinical outcomes · 2016Article
- Development of a web-based tool for the assessment of health and economic outcomes of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA).BMC medical informatics and decision making · 2015Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPublished cost-effectiveness estimates can vary considerably, both within and between countries. Despite extensive discussion, little is known empirically about factors relating to these variations.
objectivesTo use multilevel statistical modeling to integrate cost-effectiveness estimates from published economic evaluations to investigate potential causes of variation.
methodsCost-effectiveness studies of statins for cardiovascular disease prevention were identified by systematic review. Estimates of incremental costs and effects were extracted from reported base case, sensitivity, and subgroup analyses, with estimates grouped in studies and in countries. Three bivariate models were developed: a cross-classified model to accommodate data from multinational studies, a hierarchical model with multinational data allocated to a single category at country level, and a hierarchical model excluding multinational data. Covariates at different levels were drawn from a long list of factors suggested in the literature.
resultsWe found 67 studies reporting 2094 cost-effectiveness estimates relating to 23 countries (6 studies reporting for more than 1 country). Data and study-level covariates included patient characteristics, intervention and comparator cost, and some study methods (e.g., discount rates and time horizon). After adjusting for these factors, the proportion of variation attributable to countries was negligible in the cross-classified model but moderate in the hierarchical models (14%-19% of total variance). Country-level variables that improved the fit of the hierarchical models included measures of income and health care finance, health care resources, and population risks.
conclusionsOur analysis suggested that variability in published cost-effectiveness estimates is related more to differences in study methods than to differences in national context. Multinational studies were associated with much lower country-level variation than single-country studies. These findings are for a single clinical question and may be atypical.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.