PMID- 28441507
OWN - NLM
STAT- MEDLINE
DCOM- 20180530
LR  - 20180926
IS  - 1552-681X (Electronic)
IS  - 0272-989X (Linking)
VI  - 37
IP  - 8
DP  - 2017 Nov
TI  - New Metrics for Economic Evaluation in the Presence of Heterogeneity: Focusing on 
      Evaluating Policy Alternatives Rather than Treatment Alternatives.
PG  - 930-941
LID - 10.1177/0272989X17702379 [doi]
AB  - BACKGROUND: Cost-effectiveness analysis (CEA) methods fail to acknowledge that 
      where cost-effectiveness differs across subgroups, there may be differential 
      adoption of technology. Also, current CEA methods are not amenable to 
      incorporating the impact of policy alternatives that potentially influence the 
      adoption behavior. Unless CEA methods are extended to allow for a comparison of 
      policies rather than simply treatments, their usefulness to decision makers may 
      be limited. METHODS: We conceptualize new metrics, which estimate the realized 
      value of technology from policy alternatives, through introducing 
      subgroup-specific adoption parameters into existing metrics, incremental 
      cost-effectiveness ratios (ICERs) and Incremental Net Monetary Benefits (NMBs). 
      We also provide the Loss with respect to Efficient Diffusion (LED) metrics, which 
      link with existing value of information metrics but take a policy evaluation 
      perspective. We illustrate these metrics using policies on treatment with 
      combination therapy with a statin plus a fibrate v. statin monotherapy for 
      patients with diabetes and mixed dyslipidemia. RESULTS: Under the traditional 
      approach, the population-level ICER of combination v. monotherapy was 
      $46,000/QALY. However, after accounting for differential rates of adoption of the 
      combination therapy (7.2% among males and 4.3% among females), the modified ICER 
      was $41,733/QALY, due to the higher rate of adoption in the more cost-effective 
      subgroup (male). The LED metrics showed that an education program to increase the 
      uptake of combination therapy among males would provide the largest economic 
      returns due to the significant underutilization of the combination therapy among 
      males under the current policy. CONCLUSION: This framework may have the potential 
      to improve the decision-making process by producing metrics that are better 
      aligned with the specific policy decisions under consideration for a specific 
      technology.
FAU - Kim, David D
AU  - Kim DD
AD  - Center for the Evaluation of Value and Risk in Health, Institute for Clinical 
      Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA (DDK).
FAU - Basu, Anirban
AU  - Basu A
AD  - Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, and 
      the Departments of Health Services and Economics University of Washington, 
      Seattle, WA, USA (AB).
LA  - eng
PT  - Journal Article
DEP - 20170425
PL  - United States
TA  - Med Decis Making
JT  - Medical decision making : an international journal of the Society for Medical 
      Decision Making
JID - 8109073
SB  - IM
MH  - *Cost-Benefit Analysis
MH  - *Decision Making
MH  - Diffusion of Innovation
MH  - Female
MH  - *Health Policy
MH  - Humans
MH  - Male
MH  - Quality-Adjusted Life Years
MH  - Uncertainty
OTO - NOTNLM
OT  - cost-effectiveness
OT  - economic evaluation
OT  - heterogeneity
OT  - policy
OT  - technology diffusion
EDAT- 2017/04/26 06:00
MHDA- 2018/05/31 06:00
CRDT- 2017/04/26 06:00
PHST- 2017/04/26 06:00 [pubmed]
PHST- 2018/05/31 06:00 [medline]
PHST- 2017/04/26 06:00 [entrez]
AID - 10.1177/0272989X17702379 [doi]
PST - ppublish
SO  - Med Decis Making. 2017 Nov;37(8):930-941. doi: 10.1177/0272989X17702379. Epub 
      2017 Apr 25.