IDEAS home Printed from https://ideas.repec.org/a/spr/pharme/v40y2022i2d10.1007_s40273-021-01108-4.html
   My bibliography  Save this article

Factors Limiting Subgroup Analysis in Cost-Effectiveness Analysis and a Call for Transparency

Author

Listed:
  • Gemma E. Shields

    (University of Manchester)

  • Mark Wilberforce

    (University of York)

  • Paul Clarkson

    (University of Manchester)

  • Tracey Farragher

    (University of Manchester)

  • Arpana Verma

    (University of Manchester
    University of Manchester)

  • Linda M. Davies

    (University of Manchester)

Abstract

The use of population averages in cost-effectiveness analysis may hide important differences across subgroups, potentially resulting in suboptimal resource allocation, reduced population health and/or increased health inequalities. We discuss the factors that limit subgroup analysis in cost-effectiveness analysis and propose more thorough and transparent reporting. There are many issues that may limit whether subgroup analysis can be robustly included in cost-effectiveness analysis, including challenges with prespecifying and justifying subgroup analysis, identifying subgroups that can be implemented (identified and targeted) in practice, resource and data requirements, and statistical and ethical concerns. These affect every stage of the design, development and reporting of cost-effectiveness analyses. It may not always be possible to include and report relevant subgroups in cost effectiveness, e.g. due to data limitations. Reasons for not conducting subgroup analysis may be heterogeneous, and the consequences of not acknowledging patient heterogeneity can be substantial. We recommend that when potentially relevant subgroups have not been included in a cost-effectiveness analysis, authors report this and discuss their rationale and the limitations of this. Greater transparency of subgroup reporting should provide a starting point to overcoming these challenges in future research.

Suggested Citation

  • Gemma E. Shields & Mark Wilberforce & Paul Clarkson & Tracey Farragher & Arpana Verma & Linda M. Davies, 2022. "Factors Limiting Subgroup Analysis in Cost-Effectiveness Analysis and a Call for Transparency," PharmacoEconomics, Springer, vol. 40(2), pages 149-156, February.
    • Handle: RePEc:spr:pharme:v:40:y:2022:i:2:d:10.1007_s40273-021-01108-4
    DOI: 10.1007/s40273-021-01108-4
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s40273-021-01108-4
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s40273-021-01108-4?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Lee, Catherine, 2009. ""Race" and "ethnicity" in biomedical research: How do scientists construct and explain differences in health?," Social Science & Medicine, Elsevier, vol. 68(6), pages 1183-1190, March.
    2. Mark Sculpher & Amiram Gafni, 2001. "Recognizing diversity in public preferences: The use of preference sub‐groups in cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 317-324, June.
    3. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    4. Alan Brennan & Stephen E. Chick & Ruth Davies, 2006. "A taxonomy of model structures for economic evaluation of health technologies," Health Economics, John Wiley & Sons, Ltd., vol. 15(12), pages 1295-1310, December.
    5. Richard M. Nixon & Simon G. Thompson, 2005. "Methods for incorporating covariate adjustment, subgroup analysis and between‐centre differences into cost‐effectiveness evaluations," Health Economics, John Wiley & Sons, Ltd., vol. 14(12), pages 1217-1229, December.
    6. Jeffrey S. Hoch & Andrew H. Briggs & Andrew R. Willan, 2002. "Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 415-430, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Carmen Selva-Sevilla & Elena Conde-Montero & Manuel Gerónimo-Pardo, 2020. "Bayesian Regression Model for a Cost-Utility and Cost-Effectiveness Analysis Comparing Punch Grafting Versus Usual Care for the Treatment of Chronic Wounds," IJERPH, MDPI, vol. 17(11), pages 1-21, May.
    2. Noemi Kreif & Richard Grieve & Rosalba Radice & Zia Sadique & Roland Ramsahai & Jasjeet S. Sekhon, 2012. "Methods for Estimating Subgroup Effects in Cost-Effectiveness Analyses That Use Observational Data," Medical Decision Making, , vol. 32(6), pages 750-763, November.
    3. Qi Cao & Erik Buskens & Hans L. Hillege & Tiny Jaarsma & Maarten Postma & Douwe Postmus, 2019. "Stratified treatment recommendation or one-size-fits-all? A health economic insight based on graphical exploration," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 475-482, April.
    4. Jasjeet Singh Sekhon & Richard D. Grieve, 2012. "A matching method for improving covariate balance in cost‐effectiveness analyses," Health Economics, John Wiley & Sons, Ltd., vol. 21(6), pages 695-714, June.
    5. Hossein Haji Ali Afzali & Laura Bojke & Jonathan Karnon, 2018. "Model Structuring for Economic Evaluations of New Health Technologies," PharmacoEconomics, Springer, vol. 36(11), pages 1309-1319, November.
    6. Koen Degeling & Maarten J. IJzerman & Mariel S. Lavieri & Mark Strong & Hendrik Koffijberg, 2020. "Introduction to Metamodeling for Reducing Computational Burden of Advanced Analyses with Health Economic Models: A Structured Overview of Metamodeling Methods in a 6-Step Application Process," Medical Decision Making, , vol. 40(3), pages 348-363, April.
    7. F. Tomini & F. Prinzen & A. D. I. Asselt, 2016. "A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(9), pages 1159-1172, December.
    8. Richard Grieve & John Cairns & Simon G. Thompson, 2010. "Improving costing methods in multicentre economic evaluation: the use of multiple imputation for unit costs," Health Economics, John Wiley & Sons, Ltd., vol. 19(8), pages 939-954, August.
    9. Deidda, Manuela & Geue, Claudia & Kreif, Noemi & Dundas, Ruth & McIntosh, Emma, 2019. "A framework for conducting economic evaluations alongside natural experiments," Social Science & Medicine, Elsevier, vol. 220(C), pages 353-361.
    10. J. Jaime Caro & Andrew H. Briggs & Uwe Siebert & Karen M. Kuntz, 2012. "Modeling Good Research Practices—Overview," Medical Decision Making, , vol. 32(5), pages 667-677, September.
    11. Andrea Gabrio & Michael J. Daniels & Gianluca Baio, 2020. "A Bayesian parametric approach to handle missing longitudinal outcome data in trial‐based health economic evaluations," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 183(2), pages 607-629, February.
    12. G. Ramos & Antoinette Asselt & Sandra Kuiper & Johan Severens & Tanja Maas & Edward Dompeling & J. Knottnerus & Onno Schayck, 2014. "Cost-effectiveness of primary prevention of paediatric asthma: a decision-analytic model," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 869-883, November.
    13. Gomes, M & Grieve, R, 2011. "Estimating the Effects of Friendship Networks on Health Behaviors of Adolescents," Health, Econometrics and Data Group (HEDG) Working Papers 11/14, HEDG, c/o Department of Economics, University of York.
    14. Carmen Selva-Sevilla & F Dámaso Fernández-Ginés & Manuel Cortiñas-Sáenz & Manuel Gerónimo-Pardo, 2021. "Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-18, September.
    15. Emma McManus & Tracey Sach & Nick Levell, 2018. "The Use of Decision–Analytic Models in Atopic Eczema: A Systematic Review and Critical Appraisal," PharmacoEconomics, Springer, vol. 36(1), pages 51-66, January.
    16. Daisuke Goto & Ya-Chen Tina Shih & Pascal Lecomte & Melvin Olson & Chukwukadibia Udeze & Yujin Park & C. Daniel Mullins, 2017. "Regression-Based Approaches to Patient-Centered Cost-Effectiveness Analysis," PharmacoEconomics, Springer, vol. 35(7), pages 685-695, July.
    17. John Graves & Shawn Garbett & Zilu Zhou & Jonathan S. Schildcrout & Josh Peterson, 2021. "Comparison of Decision Modeling Approaches for Health Technology and Policy Evaluation," Medical Decision Making, , vol. 41(4), pages 453-464, May.
    18. Janneke Grutters & Mark Sculpher & Andrew Briggs & Johan Severens & Math Candel & James Stahl & Dirk Ruysscher & Albert Boer & Bram Ramaekers & Manuela Joore, 2013. "Acknowledging Patient Heterogeneity in Economic Evaluation," PharmacoEconomics, Springer, vol. 31(2), pages 111-123, February.
    19. Kevin Marsh & Ceri Phillips & Richard Fordham & Evelina Bertranou & Janine Hale, 2012. "Estimating cost-effectiveness in public health: a summary of modelling and valuation methods," Health Economics Review, Springer, vol. 2(1), pages 1-6, December.
    20. Kristian Bolin, 2012. "Economic Evaluation of Smoking-Cessation Therapies," PharmacoEconomics, Springer, vol. 30(7), pages 551-564, July.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:pharme:v:40:y:2022:i:2:d:10.1007_s40273-021-01108-4. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.