Second Panel on Cost-Effectiveness in Health and Medicine

Sanders GD, Neumann PJ, Basu A, et al. Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine. JAMA. 2016;316(10):1093-1103.

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In 1996, the initial panel on cost effectiveness in health and medicine published its findings emphasizing the growing filed of cost-effectiveness analysis (CEA), and its potential to inform health policy decisions. The panel made a number of recommendations to guide the conduct and use of CEA in health and medicine, with overall goals of quality improvement and comparability (Link to 1996 article). Since then, the CEA field has advanced substantially, with expanded methodology, improved theory, ethical considerations, standardized reporting, etc. The health care field has also seen significant changes, with issues like sustainability becoming prominent in recent discussions. The authors point out that there has been a substantial increase in health care spending in the US between 1996 and the present, and for all of these reasons, identified an update of the original panel’s work to be important.

The current article reviews the overall state of the field of CEA, and underlines expanded recommendations to continue quality improvement of CEA. The complete set of recommendations will be published in book form in October 2016, while the current article outlines some key recommendations including:

• Endorsing the reference case concept from the original panel, to improve the quality of CEA and promote comparability across studies; specifically recommending multiple (2) reference cases and perspectives (health care sector, societal), including quantifying and valying non-health components within an impact inventory
• Guidelines and recommendations for reporting reference cases, stating perspectives, and presenting other perspectives, highlighting the need for transparency
• Recommendations regarding the design and conduct of CEA
• Recommendations regarding reporting and interpreting CEA

The goal of the panel and their recommendations is to promote the continued evolution and refinement of the CEA process, to better support decisions regarding the use of health care resources. They note the need for future research in areas such as (1) the use of multi-criteria decision analysis and group decision making; (2) the use of CEA in value-based pricing; (3) estimation of CE thresholds; (4) the link between CEA and incentives for innovation; (5) the role of CEA within health plans or guideline development and (6) the effect of the 2 recommended reference case perspectives on the CEA and its findings