The Innovation and Value Initiative (IVI) – a collaboration of academics, patient advocacy organizations, payers, life sciences companies, providers, delivery systems, and other organizations dedicated to finding scientifically credible approaches to measuring value in health care – today released a report examining imbalances in cost-effectiveness analyses (CEAs) across pharmaceuticals, medical/surgical treatments, and mixed procedures. The report, Expanding Cost-Effectiveness to All of Health Care: Comparisons between CEAs on Pharmaceuticals and Medical/Surgical Procedures, looks at how sponsorship, the role of property rights, and sources of data vary across CEAs for different health care interventions.
To better understand how these factors influence the interventions on which CEAs are conducted, IVI analyzed data from over 200 CEAs (100 pharmaceutical and 100 medical/surgical) and 424 effectiveness studies from 2015 provided by the Tufts Medical Center Cost-Effectiveness Analysis Registry. IVI looked at the type of data and statistical technique that was used in CEAs, whether property rights and sponsorship existed, whether the CEA would be compliant with the new Second Panel on Cost-Effectiveness in Health and Medicine guidelines, and how expansive CEAs are between interventions.
Key findings from the report include:
- Pharmaceutical CEAs and effectiveness studies were primarily sponsored by industry;
- Mixed and medical/surgical CEAs and effectiveness studies were primarily sponsored by the government (via institution or grant);
- Randomized controlled trial (RCT) data was much more commonly used for pharmaceuticals, while observational data were typically used for medical/surgical studies;
- The existence of randomized controlled trial (RCT) data, sponsorship, property rights, and a lack of adoption of advanced statistical techniques all play a role in the larger number of CEAs conducted on pharmaceuticals; and
- Policies that encourage more RCTs on medical/surgical procedures would improve the standard of data available and could lead to a greater number of medical/surgical CEAs and greater overall balance between types of intervention.
“IVI is increasingly interested in using CEAs to better understand and measure the value that health care goods and services provide at a given price, but the current imbalance in cost-effectiveness analyses doesn’t give us enough information to make the most efficient decisions in health care delivery,” said Peter Neumann, member of the IVI Scientific Advisory Group and coauthor of the report. “Today’s report suggests that new policies could help us achieve a more balanced mix of CEAs across interventions and ultimately help us better diagnose and treat patients.”
“Today’s report helps us better understand the factors that may contribute to an imbalance in cost-effectiveness analyses being conducted across health care procedures,” said James Baumgardner, member of the IVI Scientific Advisory Group and coauthor of the report. “While the number of cost-effectiveness analyses on health care interventions has increased dramatically in the last two decades, research has shown that CEAs are disproportionately conducted on pharmaceutical interventions as opposed to other health care treatments and procedures. It’s important that CEAs look at all types of health care – including medical and surgical procedures – as they will continue to play a greater role in helping us measure and define value across the health care system.”