IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v14y2005i5p471-485.html
   My bibliography  Save this article

Assessing generalisability by location in trial‐based cost‐effectiveness analysis: the use of multilevel models

Author

Listed:
  • Andrea Manca
  • Nigel Rice
  • Mark J. Sculpher
  • Andrew H. Briggs

Abstract

An Erratum has been published for this article in Health Economics 14(5) 2005, 486. Cost‐effectiveness analysis (CEA) in health care is increasingly conducted alongside multicentre and multinational randomised controlled clinical trials (RCTs). The increased use of stochastic CEA is designed to account for between‐patient sampling variability in cost‐effectiveness data assuming that observations are independently distributed. However, between‐location variability in cost‐effectiveness may result if there is a hierarchical structure in the data; that is, if there is correlation in costs and outcomes between patients recruited in particular locations. This may be expected in multi‐location trials given that centres and countries often differ in factors such as clinical practice, patient case‐mix and the unit costs of delivering health care. A failure to acknowledge this feature may lead to misleading conclusions in a trial‐based economic study. Multilevel modelling (MLM) is an analytical framework that can be used to handle hierarchical cost‐effectiveness data. Using data from a recently conducted economic analysis, this paper shows how multilevel modelling can be used to obtain (a) more appropriate estimates of the population average incremental cost‐effectiveness and associated standard errors compared to standard stochastic CEA; and (b) location‐specific estimates of incremental cost‐effectiveness which can be used to explore appropriately the variability between centres/countries of the cost‐effectiveness results. Copyright © 2004 John Wiley & Sons, Ltd.

Suggested Citation

  • Andrea Manca & Nigel Rice & Mark J. Sculpher & Andrew H. Briggs, 2005. "Assessing generalisability by location in trial‐based cost‐effectiveness analysis: the use of multilevel models," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 471-485, May.
  • Handle: RePEc:wly:hlthec:v:14:y:2005:i:5:p:471-485
    DOI: 10.1002/hec.914
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.914
    Download Restriction: no

    File URL: https://libkey.io/10.1002/hec.914?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
    ---><---

    References listed on IDEAS

    as
    1. Elisabeth Fenwick & Karl Claxton & Mark Sculpher, 2001. "Representing uncertainty: the role of cost‐effectiveness acceptability curves," Health Economics, John Wiley & Sons, Ltd., vol. 10(8), pages 779-787, December.
    2. Sloan, Frank A. & Feldman, Roger D. & Steinwald, A. Bruce, 1983. "Effects of teaching on hospital costs," Journal of Health Economics, Elsevier, vol. 2(1), pages 1-28, March.
    3. 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.
    4. Nigel Rice & Andrew Jones, 1997. "Multilevel models and health economics," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 561-575, November.
    5. A. R. Cardoso, 2000. "Wage differentials across firms: an application of multilevel modelling," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 15(4), pages 343-354.
    6. M. Raikou & A. Briggs & A. Gray & A. McGuire, 2000. "Centre‐specific or average unit costs in multi‐centre studies? Some theory and simulation," Health Economics, John Wiley & Sons, Ltd., vol. 9(3), pages 191-198, April.
    7. Karl Claxton & John Posnett, "undated". "An Economic Approach to Clinical Trial Design and Research Priority Setting," Discussion Papers 96/19, Department of Economics, University of York.
    8. Aaron A. Stinnett & John Mullahy, 1998. "Net Health Benefits: A New Framework for the Analysis of Uncertainty in Cost-Effectiveness Analysis," NBER Technical Working Papers 0227, National Bureau of Economic Research, Inc.
    9. Richard J. Willke & Henry A. Glick & Daniel Polsky & Kevin Schulman, 1998. "Estimating country‐specific cost‐effectiveness from multinational clinical trials," Health Economics, John Wiley & Sons, Ltd., vol. 7(6), pages 481-493, September.
    10. Andrew H. Briggs, 1999. "A Bayesian approach to stochastic cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 8(3), pages 257-261, May.
    11. Paul Kind & Geoffrey Hardman & Susan Macran, 1999. "UK population norms for EQ-5D," Working Papers 172chedp, Centre for Health Economics, University of York.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Manca, A & Austin, P. C, 2008. "Using propensity score methods to analyse individual patient-level cost-effectiveness data from observational studies," Health, Econometrics and Data Group (HEDG) Working Papers 08/20, HEDG, c/o Department of Economics, University of York.
    2. Mark J. Sculpher & Karl Claxton & Mike Drummond & Chris McCabe, 2006. "Whither trial‐based economic evaluation for health care decision making?," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 677-687, July.
    3. Md Abu Manju & Math J. J. M. Candel & Gerard J. P. van Breukelen, 2019. "SamP2CeT: an interactive computer program for sample size and power calculation for two-level cost-effectiveness trials," Computational Statistics, Springer, vol. 34(1), pages 47-70, March.
    4. Manju, Md Abu & Candel, Math J.J.M. & van Breukelen, Gerard J.P., 2021. "Robustness of cost-effectiveness analyses of cluster randomized trials assuming bivariate normality against skewed cost data," Computational Statistics & Data Analysis, Elsevier, vol. 157(C).
    5. Fernando Antonanzas & Roberto Rodríguez‐Ibeas & Carmelo Juárez & Florencia Hutter & Reyes Lorente & Mariola Pinillos, 2009. "Transferability indices for health economic evaluations: methods and applications," Health Economics, John Wiley & Sons, Ltd., vol. 18(6), pages 629-643, June.
    6. Oliveira, Monica D. & Bevan, Gwyn, 2008. "Modelling hospital costs to produce evidence for policies that promote equity and efficiency," European Journal of Operational Research, Elsevier, vol. 185(3), pages 933-947, March.
    7. Adrian Gheorghe & Tracy E Roberts & Jonathan C Ives & Benjamin R Fletcher & Melanie Calvert, 2013. "Centre Selection for Clinical Trials and the Generalisability of Results: A Mixed Methods Study," PLOS ONE, Public Library of Science, vol. 8(2), pages 1-9, February.
    8. Lange, Ian, 2008. "Contract Parameters' Impacts on Coal Prices," Stirling Economics Discussion Papers 2008-26, University of Stirling, Division of Economics.
    9. Thompson, Simon G. & Nixon, Richard M. & Grieve, Richard, 2006. "Addressing the issues that arise in analysing multicentre cost data, with application to a multinational study," Journal of Health Economics, Elsevier, vol. 25(6), pages 1015-1028, November.
    10. Christian E. H. Boehler & Joanne Lord, 2016. "Mind the Gap! A Multilevel Analysis of Factors Related to Variation in Published Cost-Effectiveness Estimates within and between Countries," Medical Decision Making, , vol. 36(1), pages 31-47, January.
    11. Pepijn Vemer & Maureen Rutten-van Mölken, 2013. "The Road Not Taken: Transferability Issues in Multinational Trials," PharmacoEconomics, Springer, vol. 31(10), pages 863-876, October.
    12. Aline Gauthier & Andrea Manca & Susan Anton, 2009. "Bayesian Modelling of Healthcare Resource Use in Multinational Randomized Clinical Trials," PharmacoEconomics, Springer, vol. 27(12), pages 1017-1029, December.
    13. Moreno, Elías & Girón, F.J. & Vázquez-Polo, F.J. & Negrín, M.A., 2012. "Optimal healthcare decisions: The importance of the covariates in cost–effectiveness analysis," European Journal of Operational Research, Elsevier, vol. 218(2), pages 512-522.
    14. Jeffrey Hoch & Carolyn Dewa, 2007. "Lessons from Trial-Based Cost-Effectiveness Analyses of Mental Health Interventions," PharmacoEconomics, Springer, vol. 25(10), pages 807-816, October.
    15. Andrew Briggs, 2012. "Statistical Methods for Cost-effectiveness Analysis Alongside Clinical Trials," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 50, Edward Elgar Publishing.
    16. Hege Urdahl & Andrea Manca & Mark Sculpher, 2006. "Assessing Generalisability in Model-Based Economic Evaluation Studies," PharmacoEconomics, Springer, vol. 24(12), pages 1181-1197, December.
    17. Xin Sun & Thomas Faunce, 2008. "Decision-analytical modelling in health-care economic evaluations," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(4), pages 313-323, November.
    18. Andrew R. Willan & Matthew E. Kowgier, 2008. "Cost‐effectiveness analysis of a multinational RCT with a binary measure of effectiveness and an interacting covariate," Health Economics, John Wiley & Sons, Ltd., vol. 17(7), pages 777-791, July.
    19. Richard Grieve & Richard Nixon & Simon G. Thompson & John Cairns, 2007. "Multilevel models for estimating incremental net benefits in multinational studies," Health Economics, John Wiley & Sons, Ltd., vol. 16(8), pages 815-826, August.
    20. 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.
    21. Peter Makai & Willemijn Looman & Eddy Adang & René Melis & Elly Stolk & Isabelle Fabbricotti, 2015. "Cost-effectiveness of integrated care in frail elderly using the ICECAP-O and EQ-5D: does choice of instrument matter?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(4), pages 437-450, May.

    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. Karl Claxton & Elisabeth Fenwick & Mark J. Sculpher, 2012. "Decision-making with Uncertainty: The Value of Information," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 51, Edward Elgar Publishing.
    3. Richard Grieve & Richard Nixon & Simon G. Thompson & Charles Normand, 2005. "Using multilevel models for assessing the variability of multinational resource use and cost data," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 185-196, February.
    4. Rachael L. Fleurence, 2007. "Setting priorities for research: a practical application of 'payback' and expected value of information," Health Economics, John Wiley & Sons, Ltd., vol. 16(12), pages 1345-1357.
    5. Stefano Conti & Karl Claxton, 2008. "Dimensions of design space: a decision-theoretic approach to optimal research design," Working Papers 038cherp, Centre for Health Economics, University of York.
    6. Manca, A & Austin, P. C, 2008. "Using propensity score methods to analyse individual patient-level cost-effectiveness data from observational studies," Health, Econometrics and Data Group (HEDG) Working Papers 08/20, HEDG, c/o Department of Economics, University of York.
    7. Elamin H. Elbasha, 2005. "Risk aversion and uncertainty in cost‐effectiveness analysis: the expected‐utility, moment‐generating function approach," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 457-470, May.
    8. Gafni, Amiram & Birch, Stephen, 2006. "Incremental cost-effectiveness ratios (ICERs): The silence of the lambda," Social Science & Medicine, Elsevier, vol. 62(9), pages 2091-2100, May.
    9. Hoch, Jeffrey S. & Blume, Jeffrey D., 2008. "Measuring and illustrating statistical evidence in a cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 27(2), pages 476-495, March.
    10. 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.
    11. Elisabeth Fenwick & Karl Claxton & Mark Sculpher, 2001. "Representing uncertainty: the role of cost‐effectiveness acceptability curves," Health Economics, John Wiley & Sons, Ltd., vol. 10(8), pages 779-787, December.
    12. Simon Eckermann & Andrew R. Willan, 2009. "Globally optimal trial design for local decision making," Health Economics, John Wiley & Sons, Ltd., vol. 18(2), pages 203-216, February.
    13. N. J. Welton & A. E. Ades & D. M. Caldwell & T. J. Peters, 2008. "Research prioritization based on expected value of partial perfect information: a case‐study on interventions to increase uptake of breast cancer screening," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 171(4), pages 807-841, October.
    14. Elisabeth Fenwick & Karl Claxton & Mark Sculpher, 2005. "The value of implementation and the value of information: combined and uneven development," Working Papers 005cherp, Centre for Health Economics, University of York.
    15. Sennen Hounton & David Newlands, 2012. "Applying the Net-Benefit Framework for Analyzing and Presenting Cost-Effectiveness Analysis of a Maternal and Newborn Health Intervention," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-8, July.
    16. A. E. Ades & G. Lu & K. Claxton, 2004. "Expected Value of Sample Information Calculations in Medical Decision Modeling," Medical Decision Making, , vol. 24(2), pages 207-227, March.
    17. Douglas Coyle, 2003. "Determining the optimal combinations of mutually exclusive interventions: a response to Hutubessy and colleagues," Health Economics, John Wiley & Sons, Ltd., vol. 12(2), pages 159-162, February.
    18. 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.
    19. Simon Eckermann & Tim Coelli, 2008. "Including quality attributes in a model of health care efficiency: A net benefit approach," CEPA Working Papers Series WP032008, School of Economics, University of Queensland, Australia.
    20. Neil Hawkins & Mark Sculpher & David Epstein, 2005. "Cost-Effectiveness Analysis of Treatments for Chronic Disease: Using R to Incorporate Time Dependency of Treatment Response," Medical Decision Making, , vol. 25(5), pages 511-519, September.

    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:wly:hlthec:v:14:y:2005:i:5:p:471-485. 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: . General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    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: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    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.