PRM52 Systematic Review of Guideline Recommendations on Comparator Selection in Health Economic Evaluations

  • Wagner M
  • Melnyk P
  • Rindress D
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OBJECTIVES: Choice of comparator(s) is a critical design parameter for any health economic evaluation (HE). HE guidelines may differ in their recommendations on this issue. We reviewed all accessible HE guidelines to identify shared themes and differences within their recommendations on comparator selection. METHODS: We systematically searched PubMed/Medline, the Centre for Reviews and Dissemination, the EQUATOR network, and websites of health technology assessment agencies and healthcare coverage decisionmaking bodies for publicly accessible HE guidelines. Guidelines were classified as jurisdictional mandatory or non-mandatory or as general. Following review and parsing, data was extracted into a template and recommendations were coded under common, non-mutually exclusive themes. Both qualitative and quantitative analyses were performed. RESULTS: Seventyfour HE guidelines were identified and reviewed, of which 74% mentioned the issue of comparators: 96% of jurisdictional mandatory, 91% of jurisdictional non-mandatory and 58% of general guidelines. The most frequent recommendations with respect to comparator selection were to use the most common treatment (70.9% of all guidelines), to include "no intervention" when appropriate (41.8%), and to use best practice (e.g., guideline-or specialist recommended treatment) as comparator (29.1%). Other recommendations were to compare with the treatment most likely to be replaced (18.2%), to use all alternative treatments (16.4%), and the least costly treatment (14.5%). Almost half (45.5%) of guidelines specified justification of choice of comparator and 21.8% detailed description of all comparators. Mandatory jurisdictional guidelines were more likely than general guidelines to specify most common treatment (86.4% vs. 47.8%, P=0.01 Fisher's exact test), whereas general guidelines were more likely to recommend all alternative forms of therapy (30.4% vs. 4.5%, P<0.05). CONCLUSIONS: Although there are common themes among guidelines on comparator selection, differences exist of which model developers need to be aware




Wagner, M., Melnyk, P., & Rindress, D. (2012). PRM52 Systematic Review of Guideline Recommendations on Comparator Selection in Health Economic Evaluations. Value in Health, 15(4), A168.

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