Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-26T13:14:40.622Z Has data issue: false hasContentIssue false
  • English
  • Français

Are adverse effects incorporated in economic models? A survey of current practice

Published online by Cambridge University Press:  29 June 2010

Dawn Craig ,
Catriona McDaid ,
Tiago Fonseca ,
Christian Stock ,
Steven Duffy  and
Nerys Woolacott
Dawn Craig
Affiliation:
University of York
Catriona McDaid
Affiliation:
University of York
Tiago Fonseca
Affiliation:
University of York
Christian Stock
Affiliation:
University of York
Steven Duffy
Affiliation:
University of York
Nerys Woolacott
Affiliation:
University of York
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Clearly the benefits of a treatment must not be outweighed by the adverse effects. If researchers fail to incorporate adverse effects adequately in models, this could limit the validity of the results obtained. In the worst case, interventions that are cost-effective may be shown not to be. The aim of this research was to review current practice when incorporating adverse effects in economic models.

Methods: A survey of HTA reports commissioned by the National Institute for Health Research (NIHR) Health Technology Assessment programme, published between 2004 and 2007 was conducted. All reports which investigated the clinical and cost-effectiveness of a health technology using a systematic review and an economic model framework were included.

Results: A total of eighty reports met the inclusion criteria. Of the models including adverse effects (43/80), 67 percent used a clinical adverse effects parameter, 79 percent a cost of adverse effects parameter, 86 percent used one of these, and 60 percent used both. Of the thirty-seven models that did not include adverse effects, eighteen justified this omission, most commonly lack of data; nineteen appeared to make no explicit consideration of adverse effects in the model.

Conclusions: In many cases, poor reporting made it difficult to ascertain if there had been any consideration of adverse effects. We suggest that the findings of this survey support a call for much clearer and explicit reporting of adverse effects, or their exclusion, in decision models and for explicit recognition in future guidelines that “all relevant outcomes” should include some consideration of adverse events.

Keywords

Adverse effects/eventsEconomic modelsDecision modelingDecision analytic modelsCost-effectiveness analysisHealth technology assessment research
Type
METHODS
Information
International Journal of Technology Assessment in Health Care , Volume 26 , Issue 3 , July 2010 , pp. 323 - 329
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Asscher, AW, Parr, GD, Whitmarsh, VB. Towards the safer use of medicines. BMJ. 1995;311:1003–1006.CrossRefGoogle ScholarPubMed
2. Bernal-Delgado, E, Fisher, E. Abstracts in high profile journals often fail to report harm. BMC Med Res Methodol. 2008;8:14.CrossRefGoogle ScholarPubMed
3. Clark, W, Jobanputra, P, Barton, P, et al. The clinical and cost-effectiveness of anakinra for the treatment of rheumatoid arthritis in adults: A systematic review and economic analysis. Health Technol Assess. 2004;8:1–105.CrossRefGoogle ScholarPubMed
4. Cooper, N, Coyle, D, Abrams, K, et al. Use of evidence in economic decision models: An appraisal of health technology assessments in the UK since 1997. XIII Cochrane Colloquium; October 22–26, 2005; Melbourne, Australia. [Abstract 37].CrossRefGoogle Scholar
5. Cooper, N, Coyle, D, Abrams, K, et al. Use of evidence in decision models: An appraisal of health technology assessments in the UK since 1997. J Health Serv Res Policy. 2005;10:245–250.CrossRefGoogle ScholarPubMed
6. Cuervo, GL, Clarke, M. Balancing benefits and harms in health care. BMJ. 2003;327:65–66.CrossRefGoogle ScholarPubMed
7. Davies, L, Brown, TJ, Haynes, S, et al. Cost-effectiveness of cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: A systematic review and economic model. Health Technol Assess. 2006;10:1–210.CrossRefGoogle ScholarPubMed
8. Dretzke, J, Cummins, C, Sandercock, J, et al. Autoantibody testing in children with newly diagnosed type 1 diabetes mellitus. Health Technol Assess. 2004;8:1–183.CrossRefGoogle ScholarPubMed
9. Drummond, M, Iglesias, C, Cooper, N. Systematic reviews and economic evaluations conducted for the National Institute for Health and Clinical Excellence in the United Kingdom: A game of two halves? Int J Technol Assess Health Care. 2008;24:146–150.CrossRefGoogle ScholarPubMed
10. Ernst, E, Pittler, MH. Assessment of therapeutic safety in systematic reviews: Literature review. BMJ. 2001;323:546.CrossRefGoogle ScholarPubMed
11. Garside, R, Pitt, M, Somerville, M, et al. Surveillance of Barrett's oesophagus: Exploring the uncertainty through systematic review, expert workshop and economic modelling. Health Technol Assess. 2006;10:1–142.CrossRefGoogle ScholarPubMed
12. Goodacre, S, Sampson, F, Stevenson, M, et al. Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis. Health Technol Assess. 2006;10.CrossRefGoogle ScholarPubMed
13. Hartwell, D, Colquitt, J, Loveman, E, et al. Clinical effectiveness and cost-effectiveness of immediate angioplasty for acute myocardial infarction: Systematic review and economic evaluation. Health Technol Assess. 2005;9:1–99.CrossRefGoogle ScholarPubMed
14. Hopewell, S, Wolfenden, L, Clarke, M. Reporting of adverse events in systematic reviews can be improved: Survey results. J Clin Epidemiol. 2008;61:597–602.CrossRefGoogle ScholarPubMed
15. King, S, Griffin, S, Hodges, Z, et al. A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents. Health Technol Assess. 2006;10:iii–iv.CrossRefGoogle ScholarPubMed
16. Main, C, Bojke, L, Griffin, S, et al. Topotecan, pegylated liposomal doxorubicin hydrochloride and paclitaxel for second-line or subsequent treatment of advanced ovarian cancer: A systematic review and economic evaluation. Health Technol Assess. 2006;10:1–292.CrossRefGoogle ScholarPubMed
17. National Institute for Clinical Excellence. Guide to the methods of technology appraisal. London: NICE; 2008.Google Scholar
18. Philips, Z, Ginnelly, L, Sculpher, M, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess. 2004;8:1–158.CrossRefGoogle ScholarPubMed
19. Rovira, J, Antonanzas, F. Economic analysis of health technologies and programmes: A Spanish proposal for methodological standardisation. Pharmacoeconomics. 1995;8:245–252.CrossRefGoogle ScholarPubMed
20. Shepherd, J, Brodin, H, Cave, C, et al. Pegylated interferon alpha-2a and -2b in combination with ribavirin in the treatment of chronic hepatitis C: A systematic review and economic evaluation. Health Technol Assess. 2004;8:1–125.CrossRefGoogle ScholarPubMed
21. Tappenden, P, Chilcott, J, Ward, S, et al. Methodological issues in the economic analysis of cancer treatments. Eur J Cancer. 2006;42:2867–2875.CrossRefGoogle ScholarPubMed
22. Thomas, J, Brunton, J. EPPI-Reviewer 3.0: Analysis and management of data for research synthesis. EPPI-Centre software. London: Social Science Research Unit, Institute of Education. 2006.Google Scholar
23. Wardlaw, JM, Chappell, FM, Stevenson, M, et al. Accurate, practical and cost-effective assessment of carotid stenosis in the UK. Health Technol Assess. 2006;10:1–182.CrossRefGoogle ScholarPubMed
24. Weinstein, MC, O'Brien, B, Hornberger, J, et al. Principles of good practice for decision analytic modeling in health-care evaluation: Report of the ISPOR Task Force on good research practices–modeling studies. Value Health. 2003;6:9–17.CrossRefGoogle ScholarPubMed
25. Woolacott, N, Hawkins, N, Mason, A, et al. Etanercept and efalizumab for the treatment of psoriasis: A systematic review. Health Technol Assess. 2006;10:1–252.Google ScholarPubMed
26. Yao, G, Albon, E, Adi, Y, et al. A systematic review and economic model of the clinical and cost-effectiveness of immunosuppressive therapy for renal transplantation in children. Health Technol Assess. 2006;10:1–157.CrossRefGoogle ScholarPubMed