Exploring Incorporation of Adverse Events in Economic Models
Recent research has shed light on the complexities surrounding the integration of adverse events (AEs) into economic decision models. While standardization in this regard remains elusive, there are valuable insights to be gleaned from a review paper by Ghabri, Dawoud, and Drummond.
1. Strategies for Integrating AEs into Economic Models
One approach involves embedding AEs within the analytical model structure. For example, AEs could be delineated as a distinct health state, as illustrated by Stevenson et al. (2016) in their evaluation of rheumatoid arthritis treatments. This method proves most advantageous when AEs are frequent and severe. Alternatively, AEs can be introduced as input parameters for each relevant health state, considering factors like incidence rates, onset times, QoL deterioration, and associated costs per AE.
2. Classifying AEs and Terminology
AEs are typically denoted by terms such as toxicity, side effects, or adverse drug reactions. It is crucial to recognize the distinction between chronic and acute AEs. While clinical trials are a prime source for AE identification, real-world data can offer valuable insights, especially in the realm of medical devices.
3. Quantifying the Impact of AEs on QoL and Costs
Measuring the effect of AEs on quality of life often involves employing utility decrements to reflect the loss of utility across health states. The challenge lies in determining whether these decrements are already captured in the health state’s QoL. Additionally, estimating utility decrements for AEs can be complex, requiring robust regression approaches.
4. Addressing Uncertainty Surrounding AEs in ICER
Although translating clinical trial AEs to long-term outcomes is challenging, overlooking the long-term effects of AEs can skew cost-effectiveness analyses. Scenario analyses are underutilized in this context, despite their potential to illuminate crucial insights, as exemplified in evaluations related to smoking cessation.
While navigating these complexities poses challenges for researchers, leveraging best practices can enhance the robustness of economic models when factoring in AEs.
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