BMJ  2003;326:1247-1250 (7 June), doi:10.1136/bmj.326.7401.1247

Primary care

Meta-analysis of data on costs from trials of counselling in primary care: using individual patient data to overcome sample size limitations in economic analyses

¹ National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, ² Centre for the Economics of Mental Health, David Goldberg Centre, Institute of Psychiatry, London SE5 8AF, ³ Research and Development Directorate, University College London Hospitals NHS Trust, London NW1 2LT, ⁴ Centre for Occupational Psychology, University of Cardiff, Cardiff CF10 3YG, ⁵ Centre for Research in Primary and Community Care, Faculty of Health and Human Sciences, University of Hertfordshire, Hatfield AL10 9AB, ⁶ University of Greenwich, Bronte Hall, London SE9 2UG, ⁷ School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, ⁸ Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London NW3 2PF

Objective To assess the feasibility of overcoming sample size limitations in economic analyses of clinical trials through meta-analysis of data on individual patients from multiple trials.

Design Meta-analysis of individual patient data from trials of counselling in primary care compared with usual care by a general practitioner.

Setting Primary care.

Patients People with mental health problems.

Main outcome measures Direct treatment costs, depressive symptoms, and cost effectiveness.

Results Meta-analysis of individual patient data proved feasible. The results showed that the previous analyses of individual trials were underpowered to provide useful conclusions about the cost comparisons. The results are sensitive to assumptions made about the costs of sessions with a counsellor and the management of patients by a general practitioner.

Conclusions Meta-analysis of individual patient data may assist in overcoming sample size limitations in economic analyses. Although feasible, such analysis has shortcomings that may limit the validity of the results. The relative costs and benefits of this method, as opposed to further collection of primary data, are as yet unclear.

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