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Estimating country‐specific cost‐effectiveness from multinational clinical trials


  • Richard J. Willke
  • Henry A. Glick
  • Daniel Polsky
  • Kevin Schulman


Because costs and outcomes of medical treatments may vary from country to country in important ways, decision makers are increasingly interested in having data based on their own country's health care situations. This paper proposes methods for estimating country‐specific cost‐effectiveness ratios from data available from multinational clinical trials. It examines how clinical and economic outcomes interact when estimating treatment effects on cost and proposes empirical methods for capturing these interactions and incorporating them when making country‐specific estimates. We use data from a multinational phase III trial of tirilazad mesylate for the treatment of subarachnoid haemorrhage to illustrate these methods. Our findings suggest that it is possible for meaningful country‐by‐country differences to be found in such trial data. These differences can be useful in informing reimbursement, utilization, and other decisions taken at the country level. © 1998 John Wiley & Sons, Ltd.

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  • 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.
  • Handle: RePEc:wly:hlthec:v:7:y:1998:i:6:p:481-493
    DOI: 10.1002/(SICI)1099-1050(199809)7:6<481::AID-HEC353>3.0.CO;2-K

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    References listed on IDEAS

    1. Hausman, Jerry, 2015. "Specification tests in econometrics," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 38(2), pages 112-134.
    2. Michael Drummond, 1992. "Cost‐effectiveness guidelines for reimbursement of pharmaceuticals: Is economic evaluation ready for its enhanced status?," Health Economics, John Wiley & Sons, Ltd., vol. 1(2), pages 85-92, July.
    3. Davidson, Russell & MacKinnon, James G., 1993. "Estimation and Inference in Econometrics," OUP Catalogue, Oxford University Press, number 9780195060119.
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    Cited by:

    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, May.
    2. Sarah Wordsworth & Anne Ludbrook & Fergus Caskey & Alison Macleod, 2005. "Collecting unit cost data in multicentre studies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(1), pages 38-44, March.
    3. 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.
    4. Briggs, A., 2003. "Statistical Methods for Cost-Effectiveness Research: A Guide to Current Issues and Future Developments," Monographs, Office of Health Economics, number 000485, January.
    5. 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.
    6. 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.
    7. Andrew R. Willan & Eleanor M. Pinto & Bernie J. O'Brien & Padma Kaul & Ron Goeree & Larry Lynd & Paul W. Armstrong, 2005. "Country specific cost comparisons from multinational clinical trials using empirical Bayesian shrinkage estimation: the Canadian ASSENT‐3 economic analysis," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 327-338, April.
    8. Christopher J.L. Murray & David B. Evans & Arnab Acharya & Rob M.P.M. Baltussen, 2000. "Development of WHO guidelines on generalized cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 9(3), pages 235-251, April.
    9. Koopmanschap, Marc A. & Touw, Karien C. R. & Rutten, Frans F. H., 2001. "Analysis of costs and cost-effectiveness in multinational trials," Health Policy, Elsevier, vol. 58(2), pages 175-186, November.
    10. Fitzner, Karen A. & Shortridge, K. F. & McGhee, S. M. & Hedley, A. J., 2001. "Cost-effectiveness study on influenza prevention in Hong Kong," Health Policy, Elsevier, vol. 56(3), pages 215-234, June.
    11. 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.
    12. 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.
    13. Sarah Wordsworth & Anne Ludbrook, 2005. "Comparing costing results in across country economic evaluations: the use of technology specific purchasing power parities," Health Economics, John Wiley & Sons, Ltd., vol. 14(1), pages 93-99, January.
    14. 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.
    15. Castillo-Riquelme, Marianela & Chalabi, Zaid & Lord, Joanne & Guhl, Felipe & Campbell-Lendrum, Diarmid & Davies, Clive & Fox-Rushby, Julia, 2008. "Modelling geographic variation in the cost-effectiveness of control policies for infectious vector diseases: The example of Chagas disease," Journal of Health Economics, Elsevier, vol. 27(2), pages 405-426, March.

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