Adherence to the iDSI reference case among published cost-per-DALY averted studies

• Published in: PloS one Vol. 14; no. 5; p. e0205633
• Main Authors: Emerson, Joanna, Panzer, Ari, Cohen, Joshua T., Chalkidou, Kalipso, Teerawattananon, Yot, Sculpher, Mark, Wilkinson, Thomas, Walker, Damian, Neumann, Peter J., Kim, David D.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.05.2019; Public Library of Science (PLoS)
• Subjects: Adhesion; Analysis; Budgets; Cost analysis; Cost benefit analysis; Decision making; Engineering and Technology; Global Health; Health care; Health care costs; Health care facilities; Health economics; Informatics; Low income groups; Medical centers; Medical publishing; Medicine and Health Sciences; Methods; People and Places; Public health; Quality-Adjusted Life Years; Research and Analysis Methods; Sensitivity analysis; Social Sciences; Specifications; Studies; Tuberculosis; United Kingdom > UK; United States > US; South Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0205633

The iDSI reference case, originally published in 2014, aims to improve the quality and comparability of cost-effectiveness analyses (CEA). This study assesses whether the development of the guideline is associated with an improvement in methodological and reporting practices for CEAs using disability-adjusted life-years (DALYs). We analyzed the Tufts Medical Center Global Health CEA Registry to identify cost-per-DALY averted studies published from 2011 to 2017. Among each of 11 principles in the iDSI reference case, we translated all methodological specifications and reporting standards into a series of binary questions (satisfied or not satisfied) and awarded articles one point for each item satisfied. We then calculated methodological and reporting adherence scores separately as a percentage of total possible points, measured as normalized adherence score (0% = no adherence; 100% = full adherence). Using the year 2014 as the dissemination period, we conducted a pre-post analysis. We also conducted sensitivity analyses using: 1) optional criteria in scoring, 2) alternate dissemination period (2014-2015), and 3) alternative comparator classification. Articles averaged 60% adherence to methodological specifications and 74% adherence to reporting standards. While methodological adherence scores did not significantly improve (59% pre-2014 vs. 60% post-2014, p = 0.53), reporting adherence scores increased slightly over time (72% pre-2014 vs. 75% post-2014, p<0.01). Overall, reporting adherence scores exceeded methodological adherence scores (74% vs. 60%, p<0.001). Articles seldom addressed budget impact (9% reporting, 10% methodological) or equity (7% reporting, 7% methodological). The iDSI reference case has substantial potential to serve as a useful resource for researchers and policy-makers in global health settings, but greater effort to promote adherence and awareness is needed to achieve its potential.