Table 5:
Transferability of the Cost-Effectiveness Results in the Emergency Department Setting from the United Kingdom to Ontario
| Transferability Factor | Estimated Relevancea | Estimated Correspondence Between Study and Decision Countrya | Estimation of ICER of Decision Country Based on the ICER of Study Countryb |
|---|---|---|---|
| Methodological Characteristics | |||
| Perspective | Very high | Very high (Public health care payer perspective for both UK and Ontario) | Unlikely to have a large bias |
| Discount rate | Very low | Medium (UK 3.5%;54 Ontario 1.5%68) | Unlikely to have a large bias |
| Medical cost approach | High | Very high (Direct medical costs are estimated using charges, fees, average bed day, etc.54 The same costing approach is also recommended by the Canadian economic evaluation guidelines68) | Unlikely to have a large bias |
| Productivity cost approach | Not relevant (no productivity costs measured) | — | — |
| Health Care System Characteristics (Supply of Technology) | |||
| Absolute and relative prices in health care | Very high | High UK: BNP: £28.13 GBP per test (∼$50 CAD); ECHO £63.60 GBP per test (∼$111 CAD); hospital bed day £232 GBP (∼$412 CAD); GP visit £37 GBP (∼$66 CAD)54 Canada: BNP $18–$75 per test,69–71 ECHO $209 per test,72 hospital bed $815 per day,73 GP visit $7272 |
Could be slightly higher (since hospital day cost is higher in Canada, potentially there are more savings from hospital length of stay reduced) |
| Practice pattern | Very high | High Clinical management guidelines are similar2,19 Standard clinical investigations in both countries included history, physical examination, laboratory investigations, ECG, and chest x-ray. Echocardiography is performed if heart failure is confirmed or still suspected after standard clinical investigations2,19 Same cut-off values used to rule out HF in the acute care setting (BNP: < 100 pg/mL; NT-proBNP: < 300 pg/mL)2,19 |
Unlikely to have a large bias |
| Technology availability | Very high | High (Heart failure treatments are similar in UK and Ontario, e.g., pharmacotherapy, surgery2,19) | Unlikely to have a large bias |
| Population Characteristics (Demand for Technology) | |||
| Disease incidence/prevalence | Very high | Very high Incidence of HF is 3.3 per 1,000 in UK, for people ≥ 16 y;74 incidence of HF is 3.06 per 1,000 in Ontario, for people ≥ 2075 |
Unlikely to have a large bias |
| Case-mix | High | Very high UK cohort: 56% male, average age 77 y; most common comorbidities are diabetes (33%) and COPD (20%)54,76 Canadian cohort: 52% male, 93% Caucasian, average age 71 y, most common comorbidities are diabetes (27%) and COPD (31%)56 |
Unlikely to have a large bias |
| Life expectancy | High | Very high General life expectancy: UK: 18.8 y for men and 21.2 y for women aged 65 y77 Canada: 18.5 y for men and 21.6 y for women aged 65 y78 HF-specific life expectancy: for patients receiving standard care ∼30% are still alive at 4 years after discharge from index admission in both UK and Canada54,79 |
Unlikely to have a large bias |
| Health-status preferences | High | Very high UK: acute HF 0.688; chronic HF 0.75254 Canada: heart diseases 0.719 (95% CI: 0.705–0.732; 2013/14 Canadian Community Health Survey) |
Unlikely to have a large bias |
| Acceptance, compliance, incentives to patients | Very low | Very high | Unlikely to have a large bias |
| Productivity and work-loss time | Not relevant (no productivity costs measured) | – | – |
| Disease spread | Not relevant (not infectious disease) | – | – |
Abbreviations: BNP, B-type natriuretic peptide; CI, confidence interval; COPD, chronic obstructive pulmonary disease; ECG, electrocardiogram; ECHO, echocardiogram; GP, general practitioner; HF, heart failure; ICER, incremental cost-effectiveness ratio; NT-proBNP, N-terminal proBNP.
a
Response options: “Very high,” “High,” “Low,” “Very low” and “Not relevant.”65
b
Response options: “Unbiased (unlikely to have a large bias),” “Too high,” “Slightly too high,” “Too low,” and “Slightly too low.”65