IHE participates at SMDM -Society for Medical Decision Making, October 23-26 with a poster presentation on the importance of underappreciated sources of heterogeneity in economic analysis in the US.
While clinical decisions are taken for patients at the individual level, treatment choices may be constrained by coverage decisions taken at the population level. Population-level (i.e., “average”) estimates of cost and outcomes can mask important sources of heterogeneity across patients and treatment settings, and thus lead to suboptimal outcomes and an exacerbation of existing inequities in access to care. Reviews suggest that few economic evaluations account for heterogeneity, which researchers have attributed to factors like inadequate subgroup-level evidence, lack of specificity in pharmacoeconomic guidance, and ethical concerns. In addition, much of the methodological work has been developed from the single-payer perspective, and thus lacks sufficient consideration of sources of heterogeneity important in multi-payer settings. Our objective was to characterize current practices for addressing heterogeneity relevant for multi-payer settings, and to highlight key considerations for economic evaluations in the US.
Two reviews and an analysis of the Tufts Medical Center CEA Registry were sourced to identify empirical studies for the analysis. Only studies that considered at least one subgroup analysis were included. The framework for cataloging these studies was sourced from an integrative review of methods for addressing heterogeneity. The extent to which different types of heterogeneity was assessed and examples that illustrated good practices and potential challenges were highlighted.
Previous work has described six distinct types of heterogeneity. Within each type are a multitude of factors that vary systematically and may affect comparative economic evaluations. We found that most applications considered only age and treatment effects. Sources of heterogeneity arising from factors important to multi-payer settings were not adequately addressed, including differences in insurance coverage and access to care, patient preferences for health and health insurance (e.g., high vs. low deductible plans), payer and physician preferences, and variability across regions (e.g., urban vs. rural).
Economic evaluations can only be patient-centric and informative to decision-making if they are sufficiently tailored to features of the local health care ecosystem, including properly accounting for all relevant sources of heterogeneity. If economic evaluations are to be useful in the U.S. setting, findings from this study suggest that awareness must first be raised among practitioners about forms of heterogeneity arising from the unique features of its multi-payer system.
Name of conference: Society for Medical Decision Making (SMDM) 44th Annual North American Meeting
Place: Seattle, WA, US
Date: October 23-26, 2022
Type of presentation: Poster presentation
Title: The Importance of Underappreciated Sources of Heterogeneity for Economic Evaluations in the US
Name of authors: Willis Michael, Neslusan Cheryl, Nilsson Andreas
Name of Presenter: Neslusan Cheryl
The Society for Medical Decision Making aims to advance medical decision-making research and practice to improve health outcomes. Members work together with patients, clinicians, researchers, policy-makers and the public to improve the quality, patient-centeredness, and value of health decisions.