Variant Methodology Impedes Cost-effectiveness Research

June 2010, Vol 1, No 2 - AMCP Annual Meeting

San Diego—Despite increasing interest in cost-effectiveness (CE) research, the groups conducting these analyses continue to use models that are very different from each other, hampering a more precise understanding of drug comparability. This is what a team of researchers from PAREXEL Consulting (Waltham, MA) found when they examined CE studies on the world’s highest-selling drugs.

The team analyzed CE studies published in peer-reviewed journals between 1999 and 2008, seeking to understand CE trends of the 20 bestselling medications. For each analysis, they collected data on the comparator drug used, the indication, the incremental cost-effectiveness ratio (ICER), the time duration, and the type of model, among other characteristics.

The researchers found a large variability in CE for the same drugs for different indications, as well as in the methodology used by groups when determining CE for the same indications. Specifically, different groups selected various comparator drugs, used distinct overall treatment costs in the calculation, and projected the costs over dissimilar time frames, which made it difficult to compare outcomes. Primary care drugs had less variability than specialty drugs. The findings were presented at the Academy of Managed Care Pharmacy (AMCP) 22nd Annual Meeting.

Saurabh Aggarwal, PhDLead researcher Saurabh Aggarwal, PhD, notes that improvements should be made to the US healthcare system’s ICER methodology. “Unlike single payer systems, such as the United Kingdom—which has in-house experts to evaluate manufacturers’ CE models—the US system’s several hundred payers each evaluate CE differently; our system would benefit immensely if organizations such as AMCP or ISPOR [International Society for Pharmacoeconomics and Outcomes Research] would develop standards for building CE models,” he said. According to Jim Smeeding, RPh, MBA, president of the Jestarx Group and former ISPOR president, ISPOR “continues to examine ideas such as CE modeling and has begun to develop a task force to further investigate this issue.”