Lessons from trial-based cost-effectiveness analyses of mental health interventions - Why uncertainty about the outcome, estimate and willingness to pay matters
Lessons from trial-based cost-effectiveness analyses of mental health interventions - Why uncertainty about the outcome, estimate and willingness to pay matters
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DOI：
10.2165/00019053-200725100-00001
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发表时间：
2007-01-01
影响因子：
4.4
通讯作者：
Dewa, Carolyn S.
中科院分区：
文献类型：
--
作者：
Hoch, Jeffrey S.;Dewa, Carolyn S.
这篇文章的主要目的是分享作者在利用临床试验数据进行心理健康干预措施的经济评估时所学到的教训。这些经验教训相当普遍，对药物经济学研究具有明显的相关性。此外，我们还探讨了在基于临床试验数据进行经济评估时，如何使用净收益回归来加强对关键问题的考虑。我们讨论的第一项研究发现，成本效益结果因患者结果的选择和为结果支付更多费用的意愿而明显不同。第二项研究的结果也强调了支付意愿的重要性。即使有一个固定的支付意愿值，大多数情况下，新疗法具有成本效益的可能性也不是100%。在第三项研究中，新疗法的成本效益因患者特征而异。这些观察结果对药物经济学研究具有重要意义。也就是说，分析师必须仔细考虑患者结果的选择、支付意愿、患者的异质性以及数据中固有的统计不确定性。在使用患者水平的成本和效果数据进行经济评估时，净收益回归是探索这些关键问题的有用技术。
The principal aim of this article is to share lessons learned by the authors while conducting economic evaluations, using clinical trial data, of mental health interventions. These lessons are quite general and have clear relevance for pharmacoeconomic studies. In addition, we explore how net benefit regression can be used to enhance consideration of key issues when conducting an economic evaluation based on clinical trial data.The first study we discuss found that cost-effectiveness results varied markedly based on the choice of both the patient outcome and the willingness to pay for more of that outcome. The importance of willingness to pay was also highlighted in the results from the second study. Even with a set willingness-to-pay value, most of the time the probability that the new treatment was cost effective was not 100%. In the third study, the cost effectiveness of the new treatment varied by patient characteristics.These observations have important implications for pharmacoeconomic studies. Namely, analysts must carefully consider choice of patient outcome, willingness to pay, patient heterogeneity and the statistical uncertainty inherent in the data. Net benefit regression is a useful technique for exploring these crucial issues when undertaking an economic evaluation using patient-level data on both costs and effects.