Systematic review of the evidence sources applied to cost-effectiveness analyses for older women with primary breast cancer

Yubo Wang; Sean P Gavan; Douglas Steinke; Kwok-Leung Cheung; Li-Chia Chen

doi:10.1186/s12962-022-00342-7

Systematic review of the evidence sources applied to cost-effectiveness analyses for older women with primary breast cancer

Cost Eff Resour Alloc. 2022 Mar 1;20(1):9. doi: 10.1186/s12962-022-00342-7.

Authors

Yubo Wang¹, Sean P Gavan², Douglas Steinke³, Kwok-Leung Cheung⁴, Li-Chia Chen³

Affiliations

¹ Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, 1st Floor Stopford Building, Oxford Road, Manchester, M13 9PT, UK. yubo.wang@postgrad.manchester.ac.uk.
² Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
³ Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, 1st Floor Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
⁴ School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3DT, UK.

Abstract

Objective: To appraise the sources of evidence and methods to estimate input parameter values in decision-analytic model-based cost-effectiveness analyses of treatments for primary breast cancer (PBC) in older patients (≥ 70 years old).

Methods: Two electronic databases (Ovid Medline, Ovid EMBASE) were searched (inception until 5 September-2021) to identify model-based full economic evaluations of treatments for older women with PBC as part of their base-case target population or age-subgroup analysis. Data sources and methods to estimate four types of input parameters including health-related quality of life (HRQoL); natural history; treatment effect; resource use were extracted and appraised. Quality assessment was completed by reference to the Consolidated Health Economic Evaluation Reporting Standards.

Results: Seven model-based economic evaluations were included (older patients as part of their base-case (n = 3) or subgroup (n = 4) analysis). Data from younger patients (< 70 years) were used frequently to estimate input parameters. Different methods were adopted to adjust these estimates for an older population (HRQoL: disutility multipliers, additive utility decrements; Natural history: calibration of absolute values, one-way sensitivity analyses; Treatment effect: observational data analysis, age-specific behavioural parameters, plausible scenario analyses; Resource use: matched control observational data analysis, age-dependent follow-up costs).

Conclusion: Improving estimated input parameters for older PBC patients will improve estimates of cost-effectiveness, decision uncertainty, and the value of further research. The methods reported in this review can inform future cost-effectiveness analyses to overcome data challenges for this population. A better understanding of the value of treatments for these patients will improve population health outcomes, clinical decision-making, and resource allocation decisions.

Keywords: Data sources of input parameters; Decision-analytic modelling; Economic evaluation; Older women; Primary breast cancer.

Publication types

Review