IDEAS home Printed from https://ideas.repec.org/a/spr/pharmo/v4y2020i2d10.1007_s41669-019-0162-z.html
   My bibliography  Save this article

Managing Uncertainties Due to Limited Evidence in Economic Evaluations of Novel Anti-Tuberculosis Regimens: A Systematic Review

Author

Listed:
  • T. I. Armina Padmasawitri

    (Utrecht University
    Institut Teknologi Bandung)

  • Sarah Maria Saragih

    (Eötvös Loránd University (ELTE)
    Universitas Gadjah Mada)

  • Gerardus W. Frederix

    (University Medical Centre)

  • Olaf Klungel

    () (Utrecht University)

  • Anke M. Hövels

    (Utrecht University)

Abstract

Background Limited evidence for the implementation of new health technologies in low- and middle-income countries (LMICs) may lead to uncertainties in economic evaluations and cause the evaluations to produce inaccurate information for decision making. We performed a systematic review of economic evaluations on implementing new short-course regimens (SCR) for drug-sensitive and drug-resistant tuberculosis (TB), to explore how uncertainties due to the limited evidence in the studies were dealt with and to identify useful information for decision making from these studies. Methods We searched in electronic databases PubMed, EMBASE, NHSEED, and CEA registry for economic evaluations addressing the implementation of new anti-TB SCRs in LMICs published until September 2018. We included studies addressing both the cost and outcomes of implementing a new regimen for drug-sensitive and drug-resistant TB with a shorter treatment duration than the currently used regimens. The quality of the included studies was assessed using The Consensus Health Economic Criteria checklist. We extracted information from the included studies on uncertainties and how they were managed. The management of uncertainties was compared with approaches used in early health technology assessments (HTAs), including sensitivity analyses and pragmatic scenario analyses. We extracted information that could be useful for decision making such as cost-effectiveness conclusions, and barriers to implementing the intervention. Results Four of the 322 studies found in the search met the eligibility criteria. Three studies were model-based studies that investigated the cost effectiveness of a new first-line SCR. One study was an empirical study investigating the cost effectiveness of new regimens for drug-resistant TB. The model-based studies addressed uncertainties due to limited evidence through various sensitivity analyses as in early HTAs. They performed a deterministic sensitivity analysis and found the main drivers of the cost-effectiveness outcomes, that is, the rate of treatment default and treatment delivery costs. Additionally, two of the model-based studies performed a pragmatic scenario analysis and found a potential barrier to implementing the new first-line SCR, that is, a weak health system with a low TB care utilization rate. The empirical study only performed a few scenario analyses with different regimen prices and volumes of TB care utilization. Therefore, the study could only provide information on the main cost drivers. Conclusion Using an approach similar to that used in early HTAs, where uncertainties due to the limited evidence are rigorously explored upfront, the economic evaluations could inform not only the decision to implement the intervention but also how to manage risks and implementation barriers.

Suggested Citation

  • T. I. Armina Padmasawitri & Sarah Maria Saragih & Gerardus W. Frederix & Olaf Klungel & Anke M. Hövels, 2020. "Managing Uncertainties Due to Limited Evidence in Economic Evaluations of Novel Anti-Tuberculosis Regimens: A Systematic Review," PharmacoEconomics - Open, Springer, vol. 4(2), pages 223-233, June.
  • Handle: RePEc:spr:pharmo:v:4:y:2020:i:2:d:10.1007_s41669-019-0162-z
    DOI: 10.1007/s41669-019-0162-z
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s41669-019-0162-z
    File Function: Abstract
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Lara J Wolfson & Anna Walker & Robert Hettle & Xiaoyan Lu & Chrispin Kambili & Andrew Murungi & Gerhart Knerer, 2015. "Cost-Effectiveness of Adding Bedaquiline to Drug Regimens for the Treatment of Multidrug-Resistant Tuberculosis in the UK," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-20, March.
    2. Cosetta Minelli & Gianluca Baio, 2015. "Value of Information: A Tool to Improve Research Prioritization and Reduce Waste," PLOS Medicine, Public Library of Science, vol. 12(9), pages 1-5, September.
    3. Karl Claxton & Mark Sculpher & Chris McCabe & Andrew Briggs & Ron Akehurst & Martin Buxton & John Brazier & Tony O'Hagan, 2005. "Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 339-347, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 1st June 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-06-01 11:00:00

    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. A. E. Ades & Karl Claxton & Mark Sculpher, 2006. "Evidence synthesis, parameter correlation and probabilistic sensitivity analysis," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 373-381, April.
    2. Dongzhe Hong & Lei Si & Minghuan Jiang & Hui Shao & Wai-kit Ming & Yingnan Zhao & Yan Li & Lizheng Shi, 2019. "Cost Effectiveness of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, and Dipeptidyl Peptidase-4 (DPP-4) Inhibitors: A Systematic Review," PharmacoEconomics, Springer, vol. 37(6), pages 777-818, June.
    3. Pedram Sendi & Huldrych F Günthard & Mathew Simcock & Bruno Ledergerber & Jörg Schüpbach & Manuel Battegay & for the Swiss HIV Cohort Study, 2007. "Cost-Effectiveness of Genotypic Antiretroviral Resistance Testing in HIV-Infected Patients with Treatment Failure," PLOS ONE, Public Library of Science, vol. 2(1), pages 1-8, January.
    4. Newbold, Stephen C. & Johnston, Robert J., 2020. "Valuing non-market valuation studies using meta-analysis: A demonstration using estimates of willingness-to-pay for water quality improvements," Journal of Environmental Economics and Management, Elsevier, vol. 104(C).
    5. McKenna, Claire & Chalabi, Zaid & Epstein, David & Claxton, Karl, 2010. "Budgetary policies and available actions: A generalisation of decision rules for allocation and research decisions," Journal of Health Economics, Elsevier, vol. 29(1), pages 170-181, January.
    6. Mattias Ekman & Peter Lindgren & Carolin Miltenburger & Genevieve Meier & Julie Locklear & Mary Chatterton, 2012. "Cost Effectiveness of Quetiapine in Patients with Acute Bipolar Depression and in Maintenance Treatment after an Acute Depressive Episode," PharmacoEconomics, Springer, vol. 30(6), pages 513-530, June.
    7. Emma McIntosh, 2006. "Using Discrete Choice Experiments within a Cost-Benefit Analysis Framework," PharmacoEconomics, Springer, vol. 24(9), pages 855-868, September.
    8. John Hutton, 2012. "‘Health Economics’ and the evolution of economic evaluation of health technologies," Health Economics, John Wiley & Sons, Ltd., vol. 21(1), pages 13-18, January.
    9. 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.
    10. Laura Bojke & Karl Claxton & Stephen Palmer & Mark Sculpher, 2006. "Defining and characterising structural uncertainty in decision analytic models," Working Papers 009cherp, Centre for Health Economics, University of York.
    11. Nicholas Graves & Mary Courtney & Helen Edwards & Anne Chang & Anthony Parker & Kathleen Finlayson, 2009. "Cost-Effectiveness of an Intervention to Reduce Emergency Re-Admissions to Hospital among Older Patients," PLOS ONE, Public Library of Science, vol. 4(10), pages 1-9, October.
    12. Anthony Newall & Mark Jit & Philippe Beutels, 2012. "Economic Evaluations of Childhood Influenza Vaccination," PharmacoEconomics, Springer, vol. 30(8), pages 647-660, August.
    13. Christopher McCabe & Giovanni Tramonti & Andrew Sutton & Peter Hall & Mike Paulden, 2021. "Probabilistic One-Way Sensitivity Analysis with Multiple Comparators: The Conditional Net Benefit Frontier," PharmacoEconomics, Springer, vol. 39(1), pages 19-24, January.
    14. Nicholas Graves & Katie Page & Elizabeth Martin & David Brain & Lisa Hall & Megan Campbell & Naomi Fulop & Nerina Jimmeison & Katherine White & David Paterson & Adrian G Barnett, 2016. "Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-17, February.
    15. Anthony O'Hagan & Matt Stevenson & Jason Madan, 2007. "Monte Carlo probabilistic sensitivity analysis for patient level simulation models: efficient estimation of mean and variance using ANOVA," Health Economics, John Wiley & Sons, Ltd., vol. 16(10), pages 1009-1023, October.
    16. Mehdi Najafzadeh & Jorge A. Garces & Alejandra Maciel, 2017. "Economic Evaluation of Implementing a Novel Pharmacogenomic Test (IDgenetix®) to Guide Treatment of Patients with Depression and/or Anxiety," PharmacoEconomics, Springer, vol. 35(12), pages 1297-1310, December.
    17. Torbjørn Wisløff & Gunhild Hagen & Vida Hamidi & Espen Movik & Marianne Klemp & Jan Olsen, 2014. "Estimating QALY Gains in Applied Studies: A Review of Cost-Utility Analyses Published in 2010," PharmacoEconomics, Springer, vol. 32(4), pages 367-375, April.
    18. Fernando Antonanzas & Benoit Rive & Josep Badenas & Susana Gomez-Lus & Chantal Guilhaume, 2006. "Cost-effectiveness of memantine in community-based Alzheimer’s disease patients: an adaptation in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(2), pages 137-144, June.
    19. Laura Bojke & Bogdan Grigore & Dina Jankovic & Jaime Peters & Marta Soares & Ken Stein, 2017. "Informing Reimbursement Decisions Using Cost-Effectiveness Modelling: A Guide to the Process of Generating Elicited Priors to Capture Model Uncertainties," PharmacoEconomics, Springer, vol. 35(9), pages 867-877, September.
    20. Lionel Perrier & Anne Lefranc & David Pérol & Philippe Quittet & Aline Schmidt-Tanguy & Carole Siani & Christian Peretti & Bertrand Favier & Pierre Biron & Philippe Moreau & Jacques Bay & Séverine Lis, 2013. "Cost Effectiveness of Pegfilgrastim Versus Filgrastim After High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Patients with Lymphoma and Myeloma," Applied Health Economics and Health Policy, Springer, vol. 11(2), pages 129-138, April.

    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:pharmo:v:4:y:2020:i:2:d:10.1007_s41669-019-0162-z. See general information about how to correct material in RePEc.

    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). General contact details of provider: http://www.springer.com .

    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 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.

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

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.