Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, United States of America.
Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
PLoS One. 2019 May 1;14(5):e0205633. doi: 10.1371/journal.pone.0205633. eCollection 2019.
The iDSI reference case, originally published in 2014, aims to improve the quality and comparability of cost-effectiveness analyses (CEA). This study assesses whether the development of the guideline is associated with an improvement in methodological and reporting practices for CEAs using disability-adjusted life-years (DALYs).
We analyzed the Tufts Medical Center Global Health CEA Registry to identify cost-per-DALY averted studies published from 2011 to 2017. Among each of 11 principles in the iDSI reference case, we translated all methodological specifications and reporting standards into a series of binary questions (satisfied or not satisfied) and awarded articles one point for each item satisfied. We then calculated methodological and reporting adherence scores separately as a percentage of total possible points, measured as normalized adherence score (0% = no adherence; 100% = full adherence). Using the year 2014 as the dissemination period, we conducted a pre-post analysis. We also conducted sensitivity analyses using: 1) optional criteria in scoring, 2) alternate dissemination period (2014-2015), and 3) alternative comparator classification.
Articles averaged 60% adherence to methodological specifications and 74% adherence to reporting standards. While methodological adherence scores did not significantly improve (59% pre-2014 vs. 60% post-2014, p = 0.53), reporting adherence scores increased slightly over time (72% pre-2014 vs. 75% post-2014, p<0.01). Overall, reporting adherence scores exceeded methodological adherence scores (74% vs. 60%, p<0.001). Articles seldom addressed budget impact (9% reporting, 10% methodological) or equity (7% reporting, 7% methodological).
The iDSI reference case has substantial potential to serve as a useful resource for researchers and policy-makers in global health settings, but greater effort to promote adherence and awareness is needed to achieve its potential.
iDSI 参考案例最初于 2014 年发布，旨在提高成本效益分析（CEA）的质量和可比性。本研究评估了该指南的发展是否与使用残疾调整生命年（DALY）的 CEA 方法学和报告实践的改进相关。
我们分析了 Tufts 医疗中心全球卫生 CEA 登记处，以确定从 2011 年到 2017 年发表的每 DALY 成本节约研究。在 iDSI 参考案例的 11 条原则中，我们将所有方法学规范和报告标准转化为一系列二进制问题（满足或不满足），并为满足的每个项目授予文章 1 分。然后，我们分别以总可能分数的百分比计算方法学和报告依从性分数，测量为归一化依从性分数（0%=无依从性；100%=完全依从性）。使用 2014 年作为传播期，我们进行了前后分析。我们还使用以下方法进行了敏感性分析：1）评分的可选标准，2）替代传播期（2014-2015 年），和 3）替代比较器分类。
文章平均有 60%的方法学规范和 74%的报告标准依从性。虽然方法学依从性评分没有显著提高（2014 年前 59%比 2014 年后 60%，p=0.53），但报告依从性评分随着时间的推移略有增加（2014 年前 72%比 2014 年后 75%，p<0.01）。总体而言，报告依从性评分高于方法学依从性评分（74%比 60%，p<0.001）。很少有文章涉及预算影响（9%的报告，10%的方法学）或公平性（7%的报告，7%的方法学）。
iDSI 参考案例具有作为全球卫生环境中研究人员和决策者的有用资源的巨大潜力，但需要付出更大的努力来促进依从性和意识，以实现其潜力。
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