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

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


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