Determining the Baseline Strategy in a Cost-Effectiveness Analysis with Treatment Sequences

This study investigated the impact of the baseline strategy on the cost-effectiveness results, when a sequence of treatments was used. First, we reviewed submissions to the UK National Institute for Health and Care and Excellence to understand how economic models that used comparisons of treatment sequences defined the baseline strategy. We then built a simple Markov model to use as a case study. The analysis we conducted contained four hypothetical treatments of varying cost-effectiveness relationships to a fixed control (best supportive care): Treatment A was cost effective, Treatment B was extendedly dominated by Treatment A, Treatment C was cost effective, but had a greater cost than both Treatment A and Treatment B, and Treatment D was not cost effective. Our review of the National Institute for Health and Care and Excellence submissions showed that, in most cases, authors relied on clinical guidelines, expert opinion or previously developed models to define the baseline strategy (n = 31). In several cases, the choice of a baseline strategy was not explained (n = 9). Several studies used the model to identify the optimal position for the new intervention (n = 5). Using the model, all possible permutations between the hypothetical treatments were generated and ranked by their net monetary benefit. We showed that (1) a non-cost-effective treatment would never be part of an optimal sequence and (2) the choice of baseline treatment sequence can change the cost-ef...
Source: Applied Health Economics and Health Policy - Category: Health Management Source Type: research