Does the use of efficacy or effectiveness evidence in cost-effectiveness analysis matter?
To test the association of clinical evidence type, efficacy-based or effectiveness-based ("E"), versus whether or not asthma interventions' cost-effectiveness findings are favorable.



We conducted a systematic review of PubMed, EMBASE, Tufts CEA registry, Cochrane CENTRAL, and the UK National Health Services Economic Evaluation Database from 2009 to 2014.



All cost-effectiveness studies evaluating asthma medication(s) were included. Clinical evidence type, "E," was classified as efficacy-based if the evidence was from an explanatory randomized controlled trial(s) or meta-analysis, while evidence from pragmatic trial(s) or observational study(s) was classified as effectiveness-based. We defined three times the World Health Organization cost-effectiveness willingness-to-pay (WTP) threshold or less as a favorable cost-effectiveness finding. Logistic regression tested the likelihood of favorable versus unfavorable cost-effectiveness findings against the type of "E."



25 cost-effectiveness studies were included. Ten (40.0%) studies were effectiveness-based, yet 15 (60.0%) studies were efficacy-based. Of 17 studies using endpoints that could be compared to WTP threshold, 7 out of 8 (87.5%) effectiveness-based studies yielded favorable cost-effectiveness results, whereas 4 out of 9 (44.4%) efficacy-based studies yielded favorable cost-effectiveness results. The adjusted odds ratio was 15.12 (95% confidence interval; 0.59 to 388.75) for effectiveness-based versus efficacy-based achieving favorable cost-effectiveness findings. More asthma cost-effectiveness studies used efficacy-based evidence. Studies using effectiveness-based evidence trended toward being more likely to disseminate favorable cost-effective findings than those using efficacy. Health policy decision makers should pay attention to the type of clinical evidence used in cost-effectiveness studies for accurate interpretation and application.
a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice , Faculty of Pharmaceutical Sciences, Naresuan University , Phitsanulok , Thailand.|b Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus , Aurora , CO , USA.
Piyameth
P
Dilokthornsakul
a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice , Faculty of Pharmaceutical Sciences, Naresuan University , Phitsanulok , Thailand.|c School of Pharmacy, Monash University Malaysia , Selangor , Malaysia.|d School of Population Health, University of Queensland , Brisbane , Australia.|e School of Pharmacy, University of Wisconsin-Madison , Madison , WI , USA.
Nathorn
N
Chaiyakunapruk
b Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus , Aurora , CO , USA.
Jonathan D
JD
Campbell
D018927:Anti-Asthmatic Agents / Q000191:economics* / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D003362:Cost-Benefit Analysis / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D017059:Models, Econometric; D016017:Odds Ratio
D018927:Anti-Asthmatic Agents
Asthma; cost-effectiveness analysis; effectiveness; efficacy