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Assessing generalisability by location in trial-based cost-effectiveness analysis: the use of multilevel models

Manca, A., Rice, N., Sculpher, M.J. and Briggs, A.H. (2004) Assessing generalisability by location in trial-based cost-effectiveness analysis: the use of multilevel models. Health Economics, 14 (5). pp. 471-485. ISSN 1057-9230

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An Erratum has been published for this article in Health Economics 14(5) 2005, 486. Cost-effectiveness analysis (CEA) in health care is increasingly conducted alongside multicentre and multinational randomised controlled clinical trials (RCTs). The increased use of stochastic CEA is designed to account for between-patient sampling variability in cost-effectiveness data assuming that observations are independently distributed. However, between-location variability in cost-effectiveness may result if there is a hierarchical structure in the data; that is, if there is correlation in costs and outcomes between patients recruited in particular locations. This may be expected in multi-location trials given that centres and countries often differ in factors such as clinical practice, patient case-mix and the unit costs of delivering health care. A failure to acknowledge this feature may lead to misleading conclusions in a trial-based economic study. Multilevel modelling (MLM) is an analytical framework that can be used to handle hierarchical cost-effectiveness data. Using data from a recently conducted economic analysis, this paper shows how multilevel modelling can be used to obtain (a) more appropriate estimates of the population average incremental cost-effectiveness and associated standard errors compared to standard stochastic CEA; and (b) location-specific estimates of incremental cost-effectiveness which can be used to explore appropriately the variability between centres/countries of the cost-effectiveness results.

Item Type: Article
Institution: The University of York
Academic Units: The University of York > Centre for Health Economics (York)
Depositing User: York RAE Import
Date Deposited: 28 May 2009 09:14
Last Modified: 28 May 2009 09:14
Published Version: http://dx.doi.org/10.1002/hec.914
Status: Published
Publisher: John Wiley & Sons
Identification Number: 10.1002/hec.914
URI: http://eprints.whiterose.ac.uk/id/eprint/6268

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