Addressing Heterogeneity in Comparative Economic Analysis in the Decentralized US Setting: Are We Doing Enough to Support Patient-Centered Medical Decision-Making?


Discussion Leader: Michael Willis, PhD, The Swedish Institute for Health Economics, Lund, Sweden
Discussants: Tara Lavelle, PhD, Tufts Medical Center, Boston, MA, USA; Richard Chapman, PhD, MS, Innovation and Value Initiative, Alexandria, VA, USA; Kimberly Westrich, MA, Xcenda, Herndon, VA, USA


Despite evidence that treatment value often varies across patient subgroups, coverage decisions in the US are usually based on evidence aggregated at the population level. Thus, patients diverging from the average risk “being denied for being different,” as cautioned by the National Pharmaceutical Council, with suboptimal patient and economic outcomes The purpose of this workshop is to promote cross-stakeholder awareness of the implications of unaddressed heterogeneity in comparative economic analysis and discuss how best to promote evidence generation capable of supporting patient-centered decision-making.


The workshop will begin with an overview of heterogeneity in comparative economic analyses, including a discussion of important sources relevant to the decentralized US setting (e.g., socioeconomic, geographic, insurance, and provider variability). Methods to address heterogeneity and implementation challenges will be outlined (Willis, 10 minutes). Next, the consideration of heterogeneity in the US cost-effectiveness literature will be discussed, leveraging results from two Tufts Cost-Effectiveness Analysis (CEA) Registry samples. Good practices and opportunities for improvement will be illustrated via examples from the literature (Lavelle & Willis, 10 minutes). The next discussant will highlight underappreciated and under-studied sources of heterogeneity that may be particularly important in the decentralized US setting (Chapman, 10 minutes). The last discussant will present the payer perspective, including issues with implementation in health benefit design, such as resource constraints, institutional barriers, and equity concerns (Westrich, 10 minutes). An interactive case study that includes various sources of heterogeneity will be used to facilitate audience participation. This hands-on learning exercise will highlight the importance of considering all relevant sources of heterogeneity when tailoring analyses to decision problems. Different stakeholder viewpoints, evidence requirements, and barriers to implementation will be discussed (All, 20 minutes). This workshop will be valuable to researchers, payers, patient representatives, and manufacturers interested in ensuring that comparative economic analysis supports patient-centric decision-making.




Patient-Centered Research