Difference in restricted mean survival time for cost-effectiveness analysis using individual patient data meta-analysis

Evidence from a case study

MAR-LC Collaborative Group

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: In economic evaluation, a commonly used outcome measure for the treatment effect is the between-arm difference in restricted mean survival time (rmstD). This study illustrates how different survival analysis methods can be used to estimate the rmstD for economic evaluation using individual patient data (IPD) meta-analysis. Our aim was to study if/how the choice of a method impacts on cost-effectiveness results. Methods: We used IPD from the Meta-Analysis of Radiotherapy in Lung Cancer concerning 2,000 patients with locally advanced non-small cell lung cancer, included in ten trials. We considered methods either used in the field of meta-analysis or in economic evaluation but never applied to assess the rmstD for economic evaluation using IPD meta-analysis. Methods were classified into two approaches. With the first approach, the rmstD is estimated directly as the area between the two pooled survival curves. With the second approach, the rmstD is based on the aggregation of the rmstDs estimated in each trial. Results: The average incremental cost-effectiveness ratio (ICER) and acceptability curves were sensitive to the method used to estimate the rmstD. The estimated rmstDs ranged from 1.7 month to 2.5 months, and mean ICERs ranged from £ 24,299 to £ 34,934 per life-year gained depending on the chosen method. At a ceiling ratio of £ 25,000 per life year-gained, the probability of the experimental treatment being cost-effective ranged from 31% to 68%. Conclusions: This case study suggests that the method chosen to estimate the rmstD from IPD metaanalysis is likely to influence the results of cost-effectiveness analyses.

Original languageEnglish (US)
Article numbere0150032
JournalPLoS One
Volume11
Issue number3
DOIs
StatePublished - Mar 1 2016

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cost effectiveness
Cost effectiveness
Metadata
meta-analysis
Cost-Benefit Analysis
Meta-Analysis
Survival Rate
case studies
Economics
economic analysis
Ceilings
Radiotherapy
lung neoplasms
methodology
Agglomeration
Cells
radiotherapy
Survival Analysis
Non-Small Cell Lung Carcinoma
Health Care Costs

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Difference in restricted mean survival time for cost-effectiveness analysis using individual patient data meta-analysis : Evidence from a case study. / MAR-LC Collaborative Group.

In: PLoS One, Vol. 11, No. 3, e0150032, 01.03.2016.

Research output: Contribution to journalArticle

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abstract = "Objective: In economic evaluation, a commonly used outcome measure for the treatment effect is the between-arm difference in restricted mean survival time (rmstD). This study illustrates how different survival analysis methods can be used to estimate the rmstD for economic evaluation using individual patient data (IPD) meta-analysis. Our aim was to study if/how the choice of a method impacts on cost-effectiveness results. Methods: We used IPD from the Meta-Analysis of Radiotherapy in Lung Cancer concerning 2,000 patients with locally advanced non-small cell lung cancer, included in ten trials. We considered methods either used in the field of meta-analysis or in economic evaluation but never applied to assess the rmstD for economic evaluation using IPD meta-analysis. Methods were classified into two approaches. With the first approach, the rmstD is estimated directly as the area between the two pooled survival curves. With the second approach, the rmstD is based on the aggregation of the rmstDs estimated in each trial. Results: The average incremental cost-effectiveness ratio (ICER) and acceptability curves were sensitive to the method used to estimate the rmstD. The estimated rmstDs ranged from 1.7 month to 2.5 months, and mean ICERs ranged from £ 24,299 to £ 34,934 per life-year gained depending on the chosen method. At a ceiling ratio of £ 25,000 per life year-gained, the probability of the experimental treatment being cost-effective ranged from 31{\%} to 68{\%}. Conclusions: This case study suggests that the method chosen to estimate the rmstD from IPD metaanalysis is likely to influence the results of cost-effectiveness analyses.",
author = "{MAR-LC Collaborative Group} and B{\'e}ranger Lueza and Audrey Mauguen and Pignon, {Jean Pierre} and Oliver Rivero-Arias and Julia Bonastre and R. Arriagada and K. Bae and D. Ball and M. Baumann and K. Behrendt and Belani, {C. P.} and J. Beresford and J. Bishop and Bonner, {J. A.} and H. Choy and Dahlberg, {S. E.} and {De Ruysscher}, D. and S. Dische and P. Fournel and R. Koch and {Le P{\'e}choux}, C. and Mandrekar, {S. J.} and F. Mornex and M. Nankivell and G. Nelson and Parmar, {M. K.} and R. Paulus and Saunders, {M. I.} and W. Sause and Schild, {S. E.} and Turrisi, {A. T.} and A. Zajusz",
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T2 - Evidence from a case study

AU - MAR-LC Collaborative Group

AU - Lueza, Béranger

AU - Mauguen, Audrey

AU - Pignon, Jean Pierre

AU - Rivero-Arias, Oliver

AU - Bonastre, Julia

AU - Arriagada, R.

AU - Bae, K.

AU - Ball, D.

AU - Baumann, M.

AU - Behrendt, K.

AU - Belani, C. P.

AU - Beresford, J.

AU - Bishop, J.

AU - Bonner, J. A.

AU - Choy, H.

AU - Dahlberg, S. E.

AU - De Ruysscher, D.

AU - Dische, S.

AU - Fournel, P.

AU - Koch, R.

AU - Le Péchoux, C.

AU - Mandrekar, S. J.

AU - Mornex, F.

AU - Nankivell, M.

AU - Nelson, G.

AU - Parmar, M. K.

AU - Paulus, R.

AU - Saunders, M. I.

AU - Sause, W.

AU - Schild, S. E.

AU - Turrisi, A. T.

AU - Zajusz, A.

PY - 2016/3/1

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N2 - Objective: In economic evaluation, a commonly used outcome measure for the treatment effect is the between-arm difference in restricted mean survival time (rmstD). This study illustrates how different survival analysis methods can be used to estimate the rmstD for economic evaluation using individual patient data (IPD) meta-analysis. Our aim was to study if/how the choice of a method impacts on cost-effectiveness results. Methods: We used IPD from the Meta-Analysis of Radiotherapy in Lung Cancer concerning 2,000 patients with locally advanced non-small cell lung cancer, included in ten trials. We considered methods either used in the field of meta-analysis or in economic evaluation but never applied to assess the rmstD for economic evaluation using IPD meta-analysis. Methods were classified into two approaches. With the first approach, the rmstD is estimated directly as the area between the two pooled survival curves. With the second approach, the rmstD is based on the aggregation of the rmstDs estimated in each trial. Results: The average incremental cost-effectiveness ratio (ICER) and acceptability curves were sensitive to the method used to estimate the rmstD. The estimated rmstDs ranged from 1.7 month to 2.5 months, and mean ICERs ranged from £ 24,299 to £ 34,934 per life-year gained depending on the chosen method. At a ceiling ratio of £ 25,000 per life year-gained, the probability of the experimental treatment being cost-effective ranged from 31% to 68%. Conclusions: This case study suggests that the method chosen to estimate the rmstD from IPD metaanalysis is likely to influence the results of cost-effectiveness analyses.

AB - Objective: In economic evaluation, a commonly used outcome measure for the treatment effect is the between-arm difference in restricted mean survival time (rmstD). This study illustrates how different survival analysis methods can be used to estimate the rmstD for economic evaluation using individual patient data (IPD) meta-analysis. Our aim was to study if/how the choice of a method impacts on cost-effectiveness results. Methods: We used IPD from the Meta-Analysis of Radiotherapy in Lung Cancer concerning 2,000 patients with locally advanced non-small cell lung cancer, included in ten trials. We considered methods either used in the field of meta-analysis or in economic evaluation but never applied to assess the rmstD for economic evaluation using IPD meta-analysis. Methods were classified into two approaches. With the first approach, the rmstD is estimated directly as the area between the two pooled survival curves. With the second approach, the rmstD is based on the aggregation of the rmstDs estimated in each trial. Results: The average incremental cost-effectiveness ratio (ICER) and acceptability curves were sensitive to the method used to estimate the rmstD. The estimated rmstDs ranged from 1.7 month to 2.5 months, and mean ICERs ranged from £ 24,299 to £ 34,934 per life-year gained depending on the chosen method. At a ceiling ratio of £ 25,000 per life year-gained, the probability of the experimental treatment being cost-effective ranged from 31% to 68%. Conclusions: This case study suggests that the method chosen to estimate the rmstD from IPD metaanalysis is likely to influence the results of cost-effectiveness analyses.

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