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A review of cost-effectiveness analyses in rheumatology & related disciplines

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By Maetzel A, Ferraz MB, Bombardier C • www.ProHealth.com • March 25, 1998


A MEDLINE search of the 1996 and 1997 literature yielded two
reviews of the methodology of cost-effectiveness analyses
(CEAs) in the field of rheumatology and eight original CEAs
evaluating slow-acting antirheumatic agents (two studies),
total hip arthroplasty for patients with osteoarthritis (one
study), educational intervention for patients with
fibromyalgia (one study), interventions for patients with low
back pain (three studies), and hormone replacement therapy for
women with osteoporosis (one study). Most CEAs relied on
modelling of data that were assembled from various sources;
however, in one CEA a cost- effectiveness comparison was based
on data collected prospectively within a randomized clinical
trial. Extensive sensitivity analyses were conducted by a
majority of the studies. The CEAs of slow-acting antirheumatic
agents provided results that were difficult to interpret given
extensive modelling and reliance on expert estimates. Only one
CEA was supported by an industry grant. Most of the studies
were of high quality and met current methodologic
requirements, including the use of discounting, sensitivity
analysis, and incremental analysis. However, the major
shortcoming of these recent studies continues to be the use of
estimated costs instead of prospectively measured resource
utilization data presented in terms of separate physical
units.




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