Accounting for Capacity Constraints In Economic Evaluations of Stratified Medicine: A Systematic Review

• Published in: Value in health Vol. 20; no. 9; pp. A738 - A739
• Main Authors: Wright, SJ, Moore, H, Daker-White, G, Newman, W, Payne, K
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01.10.2017
• Subjects: Analysis; Budgets; Clinical trials; Constraints; Cost analysis; Diagnostic tests; Drugs; Health economics; Implementation; Intervention; Sensitivity analysis; Systematic review
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.2034

OBJECTIVES: Stratified medicines are viewed as promising interventions to safely, effectively and cost-effectively target treatment to eligible sub-groups of patients. However, the adoption of stratified medicines into practice has been slower than anticipated. Regulatory approval and reimbursement of stratified medicines creates an immediate demand for companion-diagnostic tests which were either not previously available or not prognostically useful. Health system capacity constraints can slow the implementation of stratified medicines and potentially influence their relative cost-effectiveness. This study aimed to identify if, and how, previous economic evaluations of stratified medicines had accounted for capacity constraints and the potential impact on relative cost-effectiveness. METHODS: A meta-review conducted in February 2017 used an electronic search of the EMBASE and MEDLINE databases to identify all previous systematic reviews of economic evaluations relevant to stratified medicines. Primary economic evaluations of interventions of a test-treat strategy were then collated from the published reviews. All extracted data were tabulated and a narrative analysis was used to identify whether studies had discussed potential capacity issues and whether they had used formal methods to account for these in the analysis. RESULTS: This study yielded 47 systematic reviews of economic evaluations of stratified medicines. From these reviews 165 primary economic evaluations of test-treat strategies were identified (from 2007 to 2010). Of these, 30 (18%) evaluations discussed potential capacity issues: limited health budgets; lack of quality laboratory and testing processes; ease of use of the test and results; and need for clinical and economic evidence in implementation. Methods used to account for capacity constraints included: capturing inefficiencies in trials or models; sensitivity analysis; and scenario analysis. CONCLUSIONS: Capacity constraints may impact the short-term cost-effectiveness of stratified medicines but few economic evaluations account for such constraints. Methodological developments are needed to take account of capacity constraints such as dynamic cost-effectiveness models or value of implementation analysis.