ArticlePharmacoEconomics2020
Taking the Analysis of Trial-Based Economic Evaluations to the Next Level: The Importance of Accounting for Clustering.
Article in PharmacoEconomics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Health Economic Evaluation Alongside Stepped Wedge Trials: A Methodological Systematic Review.PharmacoEconomics · 2021Pooled it
- Cost-effectiveness of percutaneous nephrostomy vs JJ stent in obstructive urolithiasis: economic evaluation alongside the STent Or NEphrostomy (STONE) randomised controlled trial.BJU international · 2026Trial
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- Behaviour change intervention (education and text) to prevent dental caries in secondary school pupils: BRIGHT RCT, process and economic evaluation.Health technology assessment (Winchester, England) · 2024Trial
- Cost-effectiveness of general practitioner- versus surgeon-led colon cancer survivorship care: an economic evaluation alongside a randomised controlled trial.Journal of cancer survivorship : research and practice · 2024Trial
- Lower urinary tract symptoms in men: the TRIUMPH cluster RCT.Health technology assessment (Winchester, England) · 2024Trial
- Trial
- Trial
- Article
- The effectiveness of a protocol without routine radiographs for follow-up of adolescent idiopathic scoliosis patients (CURVE): a study protocol.Acta orthopaedica · 2024Article
- Article
- Conducting Trial-Based Economic Evaluations Using R: A Tutorial.PharmacoEconomics · 2023Article
- The handling of missing data in trial-based economic evaluations: should data be multiply imputed prior to longitudinal linear mixed-model analyses?The European journal of health economics : HEPAC : health economics in prevention and care · 2023Article
- Article
- (Cost-)effectiveness of a personalized multidisciplinary eHealth intervention for knee arthroplasty patients to enhance return to activities of daily life, work and sports - rationale and protocol of the multicentre ACTIVE randomized controlled trial.BMC musculoskeletal disorders · 2023Article
- Cost-effectiveness of peer-supported self-management for people discharged from a mental health crisis team: methodological challenges and recommendations.Frontiers in psychiatry · 2023Article
- A scoping review of statistical methods for trial-based economic evaluations: The current state of play.Health economics · 2022Article
- Influential methods reports for group-randomized trials and related designs.Clinical trials (London, England) · 2022Article
- The statistical approach in trial-based economic evaluations matters: get your statistics together!BMC health services research · 2021Article
- Stratified care integrated with eHealth versus usual primary care physiotherapy in patients with neck and/or shoulder complaints: protocol for a cluster randomized controlled trial.BMC musculoskeletal disorders · 2021Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe aim of this study was to assess the performance and impact of multilevel modelling (MLM) compared with ordinary least squares (OLS) regression in trial-based economic evaluations with clustered data.
methodsThree thousand datasets with balanced and unbalanced clusters were simulated with correlation coefficients between costs and effects of - 0.5, 0, and 0.5, and intraclass correlation coefficients (ICCs) varying between 0.05 and 0.30. Each scenario was analyzed using both MLM and OLS. Statistical uncertainty around MLM and OLS estimates was estimated using bootstrapping. Performance measures were estimated and compared between approaches, including bias, root mean squared error (RMSE) and coverage probability. Cost and effect differences, and their corresponding confidence intervals and standard errors, incremental cost-effectiveness ratios, incremental net-monetary benefits and cost-effectiveness acceptability curves were compared.
resultsCost-effectiveness outcomes were similar between OLS and MLM. MLM produced larger statistical uncertainty and coverage probabilities closer to nominal levels than OLS. The higher the ICC, the larger the effect on statistical uncertainty between MLM and OLS. Significant cost-effectiveness outcomes as estimated by OLS became non-significant when estimated by MLM. At all ICCs, MLM resulted in lower probabilities of cost effectiveness than OLS, and this difference became larger with increasing ICCs. Performance measures and cost-effectiveness outcomes were similar across scenarios with varying correlation coefficients between costs and effects.
conclusionsAlthough OLS produced similar cost-effectiveness outcomes, it substantially underestimated the amount of variation in the data compared with MLM. To prevent suboptimal conclusions and a possible waste of scarce resources, it is important to use MLM in trial-based economic evaluations when data are clustered.
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