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Multilevel models for estimating incremental net benefits in multinational studies

  • Richard Grieve

    (Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK)

  • Richard Nixon

    (MRC Biostatistics Unit, Cambridge, UK)

  • Simon G. Thompson

    (MRC Biostatistics Unit, Cambridge, UK)

  • John Cairns

    (Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK)

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    Multilevel models (MLMs) have been recommended for estimating incremental net benefits (INBs) in multicentre cost-effectiveness analysis (CEA). However, these models have assumed that the INBs are exchangeable and that there is a common variance across all centres. This paper examines the plausibility of these assumptions by comparing various MLMs for estimating the mean INB in a multinational CEA. The results showed that the MLMs that assumed the INBs were exchangeable and had a common variance led to incorrect inferences. The MLMs that included covariates to allow for systematic differences across the centres, and estimated different variances in each centre, made more plausible assumptions, fitted the data better and led to more appropriate inferences. We conclude that the validity of assumptions underlying MLMs used in CEA need to be critically evaluated before reliable conclusions can be drawn. Copyright © 2006 John Wiley & Sons, Ltd.

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    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 16 (2007)
    Issue (Month): 8 ()
    Pages: 815-826

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    Handle: RePEc:wly:hlthec:v:16:y:2007:i:8:p:815-826
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    1. 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.
    2. Andrew R. Willan & Andrew H. Briggs & Jeffrey S. Hoch, 2004. "Regression methods for covariate adjustment and subgroup analysis for non-censored cost-effectiveness data," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 461-475.
    3. Danzon, Patricia M. & Chao, Li-Wei, 2000. "Cross-national price differences for pharmaceuticals: how large, and why?," Journal of Health Economics, Elsevier, vol. 19(2), pages 159-195, March.
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