A Bayesian approach to aid in formulary decision making: incorporating institution-specific cost-effectiveness data with clinical trial results.
Pharmacy and therapeutics committees commonly cite a lack of generalizability as a reason for not incorporating cost-effectiveness information into decision making. To address this concern, many committees undertake site-specific economic evaluations, which are often limited by small sample sizes and nonrandomized designs. We show how 2 complementary approaches were used to minimize these limitations in an economic evaluation of abciximab at 1 institution. Using a propensity score methodology, we selected patients who did not receive abciximab for the comparison cohort. Then, we adopted a Bayesian, hierarchical, random-effects model to integrate site-specific and clinical trial data. We applied the posterior distributions of effectiveness with local cost data in a traditional decision-analytic model. In 74% of the simulations, abciximab was cost-effective at 1 institution at the $50,000 per life year saved threshold, assuming a 50:50 split of patients undergoing coronary stenting and angioplasty. Among patients undergoing coronary stenting, the cost-effectiveness ratio of the addition of abciximab was at or below the $50,000 per life year saved threshold in 66.0% of the simulations.
Reed
Shelby D
SD
Pharmaceutical Outcomes Research and Policy Program, University of Washington, USA. reed0034@mc.duke.edu
Dillingham
Peter W
PW
Briggs
Andrew H
AH
Veenstra
David L
DL
Sullivan
Sean D
SD
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use; D001499:Bayes Theorem; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000188:drug therapy / Q000191:economics / Q000628:therapy; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic / Q000191:economics* / Q000379:methods
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab