Table 1. Summary of studies that met the inclusion criteria.
| Author/Year | Study aims | Number of countries included (Country EE was carried out) | Type of economic analysis | Health outcomes | EQ-5D Value set used | Study perspective | Analytic approach to the economic evaluation used | Country-specific results presented | Adjustments made to account for country variations | Discussed challenges associated with multinational studies |
|---|---|---|---|---|---|---|---|---|---|---|
| Canoui-Piotrine et al 2009 [25] | Assess the cost-effectiveness of sirolimus-eluting stents compared with bare metal stents. | 15 | Cost-effectiveness analysis and cost-utility analysis | Cost per target vessel revascularization avoided | N/A | Health service perspective | Fully split one-country costing | Yes | No | No |
| Glasziou et al 2010 [26] | Determine the cost-effectiveness of a fixed combination of perindopril and indapamide | 20 | Cost-effectiveness analysis and cost-utility analysis | Cost per death averted at 4.3 years average follow-up, cost per life year gained and cost per QALY | N/A | Healthcare purchaser perspective | Fully pooled one-country costing | Yes | Yes | Yes |
| Marcoff et al 2009 [27] | Examine the cost-effectiveness of enoxaparin compared with unfractioned heparin as adjunctive therapy for fibrinolysis | 48 | Cost-effectiveness analysis and cost utility analysis | Cost per life year gained and cost per QALY gained | N/A | Societal perspective | Fully pooled one-country costing | Yes | Yes Regression approach | Yes |
| Mittman et al 2009 [28] | Assess the cost-effectiveness of cetuximab in metastatic colorectal cancer | 2 | Cost-effectiveness and cost-utility analysis | Cost per life year gained and cost per QALY gained | N/A | Payer perspective (Canadian government) | Fully pooled one-country costing | No | No | Yes |
| Reed et al. 2004 [29] | Estimate the cost-effectiveness of zoledronic acid versus placebo for dressing skeletal complications in men with prostate cancer | 17 | Cost-effectiveness analysis and cost-utility analysis | Cost per skeletal complication avoided; cost per patient free of skeletal-related event and cost per QALY | N/A | Societal perspective | Fully pooled multi-country costing | No | Yesthrough currency conversion | Yes |
| Simon et al 2006 [31] | To assess the cost-effectiveness of using magnesium sulfate to prevent preeclampsia | 33 | Cost-effectiveness analysis | Cost per case of preeclampsia prevented | N/A | Treatment provider perspective (hospital) | Fully pooled multi-country costing | Yes region-/group-specific cost-effectiveness | Yes through currency conversion and country classification | Yes. |
| Lubell et al 2009 [32] | To explore the cost-effectiveness of artesunate versus quinine for the treatment of severe malaria | 4 | Cost-effectiveness analysis | Cost per death averted | N/A | Provider perspective | Fully pooled multi-country costing | Yes | Yes | Yes |
| Sullivan et al. 2003 [33] | Estimate the cost-effectiveness analysis of early intervention with budesonide in mild, persistent asthma | 32 | Cost-effectiveness analysis | Cost per symptom-free day | N/A | Healthcare payer and societal perspective | Fully pooled one-country costing | Yes | ||
| Briggs et al 2006 [34] | Estimate the cost-effectiveness of a single inhaler versus fluticasone proportionate in aiming for total control in asthma patients | 44 | Cost-utility analysis | Cost per QALY gained | Mapping | Health service perspective | Fully pooled one-country costing | Yes | Yes Regression approach | Yes |
| Briggs et al 2010 [35] | Inform decision makers about the cost-effectiveness of alternative COPD treatments | 42 | Cost-utility analysis | Cost per QALY gained | UK tariff | Not clear | Fully split multi-country costing | Yes region-specific | Yes | Yes |
| Lofdal et al 2005 [36] | Compare the healthcare costs and effects of budesonide/formoterol in a single inhaler with those of budesonide and formoterol monotherapies and placebo in patients with COPD | 15 | Cost-effectiveness analysis | Cost per avoided exacerbation | N/A | Healthcare payer perspective | Fully pooled one-country costing | No | Yes Followed study protocol rigorously in all countries | No |
| Bachert et al 2007 [37] | Assess the cost-effectiveness of grass allergen tablet compared with symptomatic medication for preventing seasonal grass pollen-induced rhinoconjunctivitis | 7 | Cost-utility analysis | Cost per QALY gained | UK tariff | Societal perspective | Fully split multi-country costing | Yes | No | Yes |
| Canonica et al 2007 [38] | Assess the cost-effectiveness of GRAZAX for preventing grass pollen-induced rhinoconjunctivitis | 8 | Cost-utility analysis | Cost per QALY gained | UK tariff | Societal perspective | Fully pooled multi-country costing | Yes | No | No |
| Fernandez et al 2005 [39] | Assess the relative cost-effectiveness of escitalopram compared with venlafaxine in patients with major depressive disorder | 8 | Cost-utility analysis | Cost per QALY gained | UK tariff | Payer perspective | Fully pooled multi-country costing | No | Yes Regression approach | Yes |
| Manca et al 2003 [40] | Assess the cost-effectiveness of tension-free vaginal tape compared with open burch colposuspension as a primary treatment for urodynamic stress incontinence | 2 | Cost-utility analysis | Cost per QALY gained | UK tariff | Health service perspective | Fully pooled one-country costing | No | No | |
| Garry et al. 2004 [41] | Evaluate the cost-effectiveness of laparoscopic, abdominal and vaginal hysterectomy | 2 | Cost-utility analysis | Cost per QALY gained | UK | UK NHS perspective | Fully pooled one-country costing | Yes | ||
| Nasser et al. 2008 [42] | To assess the cost-effectiveness of GRAZAX in patients with rhinoconjunctivitis and coexisting asthma | 8 | Cost-utility analysis | Cost per QALY gained | UK tariff | Societal perspective | Fully pooled one-country costing | Yes | No | No |
| Bracco et al 2007 [43] | Assess the cost-effectiveness of tegaserod in treating irritable bowel syndrome | Not stated | Cost-utility analysis | Cost per QALY gained | Appears to be UK tariff | Third-party payer perspective | Fully pooled one-country costing (check) | No | Yes Regression approach | Yes |
| Knapp et al 2008 [44] | Determine the cost-utility of treating schizophrenic patients with olanzapine compared with other antipsychotics | 10 | Cost-utility analysis | Cost per QALY gained | UK tariff | Health service perspective | Fully pooled one-country costing | No | Yes Regression approach | Yes |
| Buxton et al 2004 [46] | Assess the cost-effectiveness of early intervention with budesonide in mild asthma | 32 (Mentioned 8 in paper) | Cost-effectiveness analysis | Cost per symptom free day | N/A | Healthcare payer perspective and societal perspective | Partially split multi-country costing | Yes | Yes Used country-specific costs | Yes |
| Rutten Von Molken et al 2007 [47] | Assess the cost-effectiveness analysis of roflumilast for treating patients with severe chronic obstructive pulmonary disease | 14 | Cost-effectiveness analysis | Cost per exacerbation avoided | N/A | Societal and NHS perspectives | Fully pooled one-country costing | No | Yes through currency conversion | Yes |
| Willan et al 2006 [48] | Assess the cost-effectiveness of rivastigmine in patients with Parkinson’s disease dementia | 12 | Cost-utility analysis | Cost per QALY gained | N/A | Societal perspective | Fully pooled multi- country costing | Yes Regression approach | Yes | |
| Radeva et al 2005 [49] | Determine the cost-effectiveness of everolimus compared with azathioprine one year after de novo heart transplantation | 14 | Cost-effectiveness analysis | Cost per additional patient free of efficacy failure | N/A | Societal perspective | Fully pooled multi-country costing | No | Yes Regression approach | No |
| Edbrooke et al 2011 [50] | To assess the implications of intensive care unit triage decisions on patient mortality | 7 | Cost-effectiveness analysis | Cost per life-year saved and cost per life year | N/A | Not clear | Fully pooled multi-country costing | No | Yes Regression approach | Yes |
| Lamy et al 2004 [51] | Assess the cost-effectiveness of the use of clopidogrel in acute coronary syndromes | 28 | Cost-effectiveness analysis | Cost per CV death prevented | N/A | Societal perspective | Fully pooled multi-country costing | Yes | Yes Regression approach and event costs | Yes |
| Drummond et al 2003 [52] | Determine the cost-effectiveness of sequential i.v./po moxifloxacin therapy compared with i.v./po co-amoxiclav with or without clarithromycin in treating community-acquired pneumonia | 10 | Cost-effectiveness analysis | Cost per additional patient cured | N/A | Health service perspective | Fully pooled one country costing | Yes | Yes Regression approach | Yes |
| Gomes et al. 2010 [53] | Assess the cost-effectiveness of general versus local anesthesia for carotid surgery | 24 | Cost-effectiveness analysis | Cost per event-free day | N/A | Health service and personal social services | Fully pooled one-country costing | Yes | No | Yes |
| Lorgelly et al 2010 [55] | Assess the cost-effectiveness of rosuvastatin treatment in systolic heart failure | 21 | Cost-effectiveness analysis | Cost per major CV event avoided | N/A | Healthcare perspective | Fully pooled one-country costing | No | Yes Used event cost | Yes |
| Price et al 2002 [57] | Assess the cost-effectiveness of chlorofluorocarbon-free beclomethasone dipropionate in treating chronic asthma | 4 | Cost-effectiveness analysis | Cost per symptom free day | N/A | Healthcare provider | Fully pooled one-country costing | Yes appeared to be UK | Yes Adjusted resource use | Yes |
| Weintraub et al 2005 [58] | Assess the long-term cost-effectiveness of clopidogrel in patients with acute coronary syndromes | 28 | Cost-effectiveness analysis | Cost per life year gained | N/A | Societal perspective | Fully polled one-country costing | Yes | No | Yes |
| Wade et al 2008 [59] | Evaluate the cost-effectiveness of escitalopram versus duloxetine in treating major depressive disorder | 9 | Cost-effectiveness analysis | Change in Sheehan Disability Scale | N/A | Societal perspective | Fully pooled one-country costing | No | Yes Regression approach | Yes |
| Kolm 2007 [60] | Assess the cost-effectiveness of clopidogrel in acute coronary syndromes | 28 | Cost-effectiveness analysis | Cost per life year gained | N/A | Canadian health system | Fully pooled one-country costing | Yes | Yes | Yes |
| Jowett et al 2009 [61] | Assess the cost-effectiveness of computer-assisted anticoagulant dosage versus manual dosing in patients on long- or short-term oral anticoagulant therapy | 13 | Cost-effectiveness analysis | Cost per clinical event avoided | N/A | Healthcare perspective | Fully pooled one-country costing | No | No | Yes |
| Dukhovny et al 2011 [62] | Evaluate the cost-effectiveness of caffeine for apnea of prematurity | 9 | Cost-effectiveness analysis | Survival without bronchopulmonary dysplasia (BPD) or neurodevelopmental impairment (NDI) | N/A | Third-party payer perspective | Fully pooled one-country costing | No | Yes Regression approach | Yes |
| Annemans et al 2003 [81] | Assess the cost-effectiveness of recombinant urate oxidase in hematological cancer patients | 4 | Cost-effectiveness analysis | Cost per life year saved | N/A | Healthcare payer | Fully pooled multi-country costing | Yes | No | |
| Aspelin et al 2005 [82] | Assess the cost-effectiveness of iodixanol in patients at high risk of contrast-induced nephropathy | 5 | Cost-effectiveness analysis | Cost per adverse drug reaction avoided | N/A | Hospital perspective | Fully pooled one-country costing | Yes | No | |
| Bakhai et al. 2003 [83] | Evaluate the cost-effectiveness of coronary stenting and abciximab for patients with acute myocardial infarction | 9 | Cost-utility analysis | Cost per QALY gained | N/A | Third-party payer perspective | Fully split one-country costing | Yes | No | No |
| Brown et al. 2003 [84] | Establish the cost-effectiveness of eptifibatide treatment for acute coronary syndrome patients | 28 | Cost-effectiveness analysis | Cost per life year gained | N/A | Fully split one-country costing | Yes | No | No | |
| Janzon et al 2003 [85] | Assess the cost-effectiveness of extended treatment with low molecular weight heparin (dalteparin) in unstable coronary artery disease | 3 | Cost-effectiveness analysis | Cost per avoided death or myocardial infarction | N/A | Healthcare provider perspective | Fully pooled one-country costing | No | Yes Tested the impact of price differences between countries | No |
| Lamy et al 2003 [86] | Assess the cost implication of using ramipril in high-risk patients based on the heart outcomes prevention evaluation (HOPE) study | 19 | Cost-effectiveness analysis | Cost per primary event saved | N/A | Third-party payer perspective | Fully pooled one-country costing | Yes | No | No |
| Lindgren et al. 2005 [87] | Assess the cost-effectiveness of formoterol and salbutamol in patients with asthma | 24 | Cost-effectiveness analysis | Cost per avoided severe exacerbation | N/A | Healthcare payer perspective | Fully pooled multi-country costing | Yes | No | No |
| Martin et al 2003 [88] | Determine the cost-effectiveness of epoetin-Alfa versus placebo in stage IV breast cancer. | 15 | Cost-utility analysis | Cost per QALY gained | N/A | Health service perspective | Fully pooled one-country costing (Not clear) | No | No | No |
| Reed et al 2004 [89] | Assess the cost-effectiveness of valsartan in patients with chronic heart failure | 16 | Cost-effectiveness analysis | Cost per life year saved | N/A | Societal perspective | Fully pooled multi-country costing | No | Yes Used country-specific costing and other approaches | Yes |
| Welsch et al 2009 [90] | Cost-effectiveness of enoxaparin compared with unfractionated heparin in ST elevation myocardial infarction patients | 48 | Cost-effectiveness analysis | Cost per life year gained | NA | Fully pooled one-country costing | Yes | No | Yes |
I A fully pooled analysis is a study that relies on resource use and effectiveness data from all participating countries II A fully split analysis is one that relies on resource use and effectiveness from one or a subset of countries. III Partially split analysis relies on effectiveness data from all participating countries but relies on resource use data from one or a subset of countries. IV One-country costing applies the unit cost from one country V Multi-country costing applies unit costs from two or more participating countries.