title: Potential role of network meta-analysis in value-based insurance design.
abstract: OBJECTIVE
  Value-based insurance design (V-BID) has emerged as an approach to improve health outcomes and contain healthcare costs by encouraging use of high-value care. We estimated the impact of a V-BID for osteoporosis treatments using comparative effectiveness evidence and real-world data from a California health insurance plan to estimate the benefits of the design's implementation.
  
  
  METHODS
  This study consisted of 4 steps. First, we reviewed randomized clinical trials including osteoporosis treatments-alendronate, ibandronate, risedronate, raloxifene, and teriparatide-reported in a recent Agency for Health Research Quality systematic review. Second, we performed a network meta-analysis to synthesize data from the clinical trials and estimate the comparative effectiveness of included treatments. Third, we implemented a V-BID by removing co-payments for the most effective treatments. Fourth, using a Monte Carlo simulation, we estimated the impact of the V-BID in terms of fracture reduction and cost-savings.
  
  
  RESULTS
  Thirty-two randomized controlled trials were included in the network meta-analysis. We estimated that alendronate, risedronate, and teriparatide have the highest probability of being most effective across each fracture type-vertebral, hip, and nonvertebral/ nonhip. After eliminating co-payments, (ie, reducing them to zero), for these treatments, we estimated the health plan would experience a 7% (n = 287) decrease in fractures and an 8% ($6.8 million) decrease in costs.
  
  
  CONCLUSIONS
  Our study illustrates the benefits of comparative effectiveness evidence in V-BID development. We show that where clinical trials are lacking, network meta-analysis can provide valuable insights into the potential clinical and economic benefits of V-BID.
authors.affiliation: The Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Boston, MA 02111. E-mail: JChambers@tuftsmedicalcenter.org.
authors.forename: James D
authors.initials: JD
authors.lastname: Chambers
authors.forename: Aaron
authors.initials: A
authors.lastname: Winn
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhong
authors.forename: Natalia
authors.initials: N
authors.lastname: Olchanski
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cangelosi
mesh_terms: D002140:California; D057186:Comparative Effectiveness Research; D017046:Cost Savings / Q000379:methods; D006801:Humans; D007348:Insurance, Health / Q000458:organization & administration*; D015201:Meta-Analysis as Topic; D010024:Osteoporosis / Q000191:economics / Q000628:therapy; D012052:Reimbursement, Incentive / Q000458:organization & administration; D016896:Treatment Outcome; D062505:Value-Based Purchasing / Q000458:organization & administration*