Stratified cost-effectiveness analysis: a framework for establishing efficient limited use criteria.
The cost-effectiveness of new health care technologies is conditional upon who receives what therapy and under what circumstances. Understanding this heterogeneity in cost-effectiveness, health care payers often limit reimbursement of therapies to a more restrictive sub-group of patients than that indicated in a product's licensing. Such limits may be based upon clinical or demographic criteria that are prognostic of costs, outcomes or both. However, there is little guidance on how to estimate and interpret stratified cost-effectiveness analysis. In this paper we present a framework for estimating the benefits from stratification that permits consideration of both the opportunity cost resulting from a lack of adherence with criteria and the efficiency loss associated with incorporating equity concerns.
Coyle
Douglas
D
Department of Medicine, University of Ottawa, and Ottawa Health Research Institute, Ottawa, ON, Canada. dcoyle@ohri.ca
Buxton
Martin J
MJ
O'Brien
Bernie J
BJ
D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D004526:Efficiency; D005343:Fibrinolytic Agents / Q000191:economics / Q000627:therapeutic use; D019983:Guideline Adherence; D006297:Health Services Accessibility; D006801:Humans; D007349:Insurance, Health, Reimbursement; D017059:Models, Econometric; D009203:Myocardial Infarction / Q000188:drug therapy / Q000191:economics; D018579:Patient Selection; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D013300:Streptokinase / Q000191:economics / Q000627:therapeutic use; D013673:Technology Assessment, Biomedical / Q000191:economics*; D015912:Thrombolytic Therapy / Q000191:economics; D010959:Tissue Plasminogen Activator / Q000191:economics / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010959:Tissue Plasminogen Activator