Crespo Carlos, Monleon Antonio, Díaz Walter, Ríos Martín
Statistical Department, Facultat de Biologia, University of Barcelona, Avda Diagonal 645, 08028 Barcelona, Spain.
BMC Med Res Methodol. 2014 Dec 22;14:139. doi: 10.1186/1471-2288-14-139.
The aim of this study was to create a new meta-analysis method for cost-effectiveness studies using comparative efficiency research (COMER).
We built a new score named total incremental net benefit (TINB), with inverse variance weighting of incremental net benefits (INB). This permits determination of whether an alternative is cost-effective, given a specific threshold (TINB > 0 test). Before validation of the model, the structure of dependence between costs and quality-adjusted life years (QoL) was analysed using copula distributions. The goodness-of-fit of a Spanish prospective observational study (n = 498) was analysed using the Independent, Gaussian, T, Gumbel, Clayton, Frank and Placket copulas. Validation was carried out by simulating a copula distribution with log-normal distribution for costs and gamma distribution for disutilities. Hypothetical cohorts were created by varying the sample size (n: 15-500) and assuming three scenarios (1-cost-effective; 2-non-cost-effective; 3-dominant). The COMER result was compared to the theoretical result according to the incremental cost-effectiveness ratio (ICER) and the INB, assuming a margin of error of 2,000 and 500 monetary units, respectively.
The Frank copula with positive dependence (-0.4279) showed a goodness-of-fit sufficient to represent costs and QoL (p-values 0.524 and 0.808). The theoretical INB was within the 95% confidence interval of the TINB, based on 15 individuals with a probability > 80% for scenarios 1 and 2, and > 90% for scenario 3. The TINB > 0 test with 15 individuals showed p-values of 0.0105 (SD: 0.0411) for scenario 1, 0.613 (SD: 0.265) for scenario 2 and < 0.0001 for scenario 3.
COMER is a valid tool for combining cost-effectiveness studies and may be of use to health decision makers.
本研究的目的是创建一种使用比较效率研究（COMER）进行成本效益研究的新的荟萃分析方法。
我们构建了一个名为总增量净效益（TINB）的新分数，对增量净效益（INB）采用逆方差加权。这允许在给定特定阈值（TINB>0检验）的情况下确定一种替代方案是否具有成本效益。在模型验证之前，使用copula分布分析成本与质量调整生命年（QoL）之间的依赖结构。使用独立、高斯、T、耿贝尔、克莱顿、弗兰克和普拉科特copula分析了一项西班牙前瞻性观察性研究（n = 498）的拟合优度。通过模拟成本服从对数正态分布、负效用服从伽马分布的copula分布进行验证。通过改变样本量（n：15 - 500）并假设三种情景（1 - 具有成本效益；2 - 不具有成本效益；3 - 占优）创建假设队列。分别假设误差幅度为2000和500货币单位，根据增量成本效益比（ICER）和INB将COMER结果与理论结果进行比较。
具有正相关性（-0.4279）的弗兰克copula显示出足以代表成本和QoL的拟合优度（p值分别为0.524和0.808）。基于15名个体，理论INB在TINB的95%置信区间内，情景1和情景2的概率>80%，情景3的概率>90%。对于情景1，15名个体的TINB>0检验显示p值为0.0105（标准差：0.0411），情景2为0.613（标准差：0.265），情景3<0.0001。
COMER是一种用于综合成本效益研究的有效工具，可能对卫生决策者有用。
