Comparative analyses of published cost effectiveness models highlight critical considerations which are useful to inform development of new models

Abstract

Background: Comparative analyses of published cost effectiveness models provide useful insights into critical issues to inform the development of new cost effectiveness models in the same disease area.

Objective: The purpose of this study was to describe a comparative analysis of cost-effectiveness models and highlight the importance of such work in informing development of new models. This research uses genotypic antiretroviral resistance testing after first line treatment failure for Human Immunodeficiency Virus (HIV) as an example.

Method: A literature search was performed, and published cost effectiveness models were selected according to predetermined eligibility criteria. A comprehensive comparative analysis was undertaken for all aspects of the models.

Results: Five published models were compared, and several critical issues were identified for consideration when developing a new model. These include the comparator, time horizon and scope of the model. In addition, the composite effect of drug resistance prevalence, antiretroviral therapy efficacy, test performance and the proportion of patients switching to second-line ART potentially have a measurable effect on model results. When considering CD4 count and viral load, dichotomizing patients according to higher cost and lower quality of life (AIDS) versus lower cost and higher quality of life (non-AIDS) status will potentially capture differences between resistance testing and other strategies, which could be confirmed by cross-validation/convergent validation. A quality adjusted life year is an essential outcome which should be explicitly explored in probabilistic sensitivity analysis, where possible.

Conclusions: Using an example of GART for HIV, this study demonstrates comparative analysis of previously published cost effectiveness models yields critical information which can be used to inform the structure and specifications of new models.

Keywords:

• Comparative analysis
• economic evaluation
• cost effectiveness modeling
• health economics methodology

JEL CLASSIFICATION CODE:

• I10

Transparency

Declaration of funding

This study is funded by the National Institute of Allergy and Infectious Diseases with support from the President’s Emergency Plan for AIDS Relief (NIH R01 AI124718). MJS receives additional support from the National Institutes of Mental Health (K23 MH099916). VCM and RTG receive additional support from NIH/NIAID.

Declaration of financial/other interests

The authors have no relevant financial or other relationships to disclose.

JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conception and design: all; analysis and interpretation of the data: TR, GG, MJS; drafting of the article: TR; critical revision of the article for important intellectual content: all; obtaining of funding: MJS.

Acknowledgements

Thank you to Debra Kiss for review of the manuscript. Thank you to Ute Zerwes who performed the literature searches, Maggie Feng and Rebecca Fain Gilbert who sourced the literature and Michael Strauss who provided expertise in standardizing the results.

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