Patient Variability Seldom Assessed in Cost-Effectiveness Studies


This article in Medical Decision Making reviews 200 articles published in 2014 to determine whether each cost-effectiveness analysis (CEA) study reported subgroup results and collected data on the defining characteristics of these subgroups. Since estimates can vary across patient subgroups when characteristics are influenced by preferences, outcome risks, treatment effectiveness, life expectancy, or associated costs it can be important to track and report these differences. 

The authros identified whether any of the CEA subgroup results crossed conventional cost-effectiveness benchmarks (e.g., $100,000 per QALY) and compared characteristics of studies with and without subgroup-specific findings. Thirty-eight studies (19%) reported patient subgroup results - and these were more likely to be US-based and government funded with a focus on primary or secondary. Among the 23 stratifications reported alongside average ratios in US studies, 13 produced subgroup ratios that crossed a conventional CEA ratio benchmark. The authors conluded that even though most CEAs do not report subgroup results, and those that do often stratify only by patient age - over half of the subgroup analyses reported could lead to different value-based decision making for at least some patients.


Lavelle TA, Kent DM, Lundquist CM et al. Patient Variability Seldom Assessed in Cost-Effectiveness Studies. Medical Decision Making 2018.

Not open access.