Promoting confidence in cost-effectiveness analyses

In a linked paper, Xie and colleagues (doi:10.1136/bmj-2021-069573)1 report a comprehensive investigation into the presence of bias in cost-effectiveness analyses conducted with sponsorship from the pharmaceutical or medical device industry. The authors used the Tufts Cost-Effectiveness Analysis Registry to analyse 8192 cost-effectiveness analyses, of which 29.7% were sponsored by industry. Industry-sponsored studies were twice as likely to report the intervention being studied as cost-effective at a willingness-to-pay threshold of $50 000 per quality adjusted life years (QALY) gained (odds ratio 2.06; 95% confidence interval 1.82-2.33). These findings are important because the studies listed in this comprehensive registry might directly influence organisations that use cost-effectiveness analysis in decision making.

Cost-effectiveness analysis can be a useful tool to aid system-level decision making about the adoption of new health technologies. However, this usefulness is directly related to the quality of the analysis and the confidence that decision-makers might have in its accuracy. Assumptions made during …