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Cost-Effectiveness Analysis Alongside Clinical Trials II—An ISPOR Good Research Practices Task Force Report
Open accessAbstract
Clinical trials evaluating medicines, medical devices, and procedures now commonly assess the economic value of these interventions. The growing number of prospective clinical/economic trials reflects both widespread interest in economic information for new technologies and the regulatory and reimbursement requirements of many countries that now consider evidence of economic value along with clinical efficacy. As decision makers increasingly demand evidence of economic value for health care interventions, conducting high-quality economic analyses alongside clinical studies is desirable because they broaden the scope of information available on a particular intervention, and can efficiently provide timely information with high internal and, when designed and analyzed properly, reasonable external validity. In 2005, ISPOR published the Good Research Practices for Cost-Effectiveness Analysis Alongside Clinical Trials: The ISPOR RCT-CEA Task Force report. ISPOR initiated an update of the report in 2014 to include the methodological developments over the last 9 years. This report provides updated recommendations reflecting advances in several areas related to trial design, selecting data elements, database design and management, analysis, and reporting of results. Task force members note that trials should be designed to evaluate effectiveness (rather than efficacy) when possible, should include clinical outcome measures, and should obtain health resource use and health state utilities directly from study subjects. Collection of economic data should be fully integrated into the study. An incremental analysis should be conducted with an intention-to-treat approach, complemented by relevant subgroup analyses. Uncertainty should be characterized. Articles should adhere to established standards for reporting results of cost-effectiveness analyses. Economic studies alongside trials are complementary to other evaluations (e.g., modeling studies) as information for decision makers who consider evidence of economic value along with clinical efficacy when making resource allocation decisions.
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“The economic evaluation will be performed from a societal perspective, and all analyses will be conducted according to the intention-to-treat principle, in which we adhere to the related guidelines [67–69].”
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“For example, parameter uncertainty will be covered by, for example, sensitivity analyses in which imputed uncertainty is also taken into account by repeating the economic evaluation on the imputed dataset and sampling uncertainty will be taken into account by providing a cost-effectiveness acceptability curve and frontier [67].”
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“Best practice within-trial economic evaluation methods will be adopted53”
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Molassiotis, A., Dawkins, B., Longo, R., Suen, L. K. P., Cheng, H., Mok, T. S. K., Hulme, C. T., & Yeo, W. (2020) · Acupuncture in Medicine · doi:10.1177/0964528420920285 · Cited by 11
“This approach is recommended for economic analyses conducted alongside clinical trials as it reflects the uncertainty inherent in replacing missing data.(26) The imputation was performed in Stata Version 14 using predictive mean matching to perform multiple imputation by chained equations.”
MethodBosetti, R., Tabatabai, L. S., Naufal, G., Menser, T. L., & Kash, B. A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0260139 · Cited by 16
“Economic data should be fully collected as well to make trial-based cost-effectiveness studies possible [45].”
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“Because of the historical absence of a priori cost-effectiveness analysis power calculations in pivotal cancer trials [5, 11], we have also developed an easy-to-use online program (http:// stata pps. tk/ icer_ sampl esize), for analysts to calculate power and sample size at the design stage of…”
BackgroundMethodInfluentialFamuyide, A. O., Laughlin-Tommaso, S. K., Shazly, S. A., Long, K. H., Breitkopf, D. M., Weaver, A. L., McGree, M. E., El‐Nashar, S. A., Lemens, M. A., & Hopkins, M. R. (2017) · PLoS ONE · doi:10.1371/journal.pone.0188176 · Cited by 11
Tuffaha, H., El-Saifi, N., Chambers, S., & Scuffham, P. (2018) · Psycho-Oncology · doi:10.1002/pon.4933 · Cited by 11
“Furthermore, clinical trials have restrictions regarding the inclusion and exclusion criteria of participants together with protocol‐driven costs and outcomes data collection, and thus, the data from a given trial population may not be generalizable to other populations and or jurisdictions.(12) In addition, the follo…”
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Lourenço, R. D. A., Khoo, T., Crothers, A., Haas, M. R., Montgomery, R., Ball, D., Bressel, M., & Siva, S. (2022) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2022.01.024 · Cited by 11
Regression-Based Approaches to Patient-Centered Cost-Effectiveness Analysis
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Interventions to increase attendance for diabetic retinopathy screening
Lawrenson, J. G., Graham-Rowe, E., Lorencatto, F., Presseau, J., Burr, J., Ivers, N., Quartilho, A., Bunce, C., Francis, J. J., Grimshaw, J. M., et al. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012054 · Cited by 10
Comments on the 2025 Edition of China Guidelines for Pharmacoeconomic Evaluations
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Ridyard, C., Plumpton, C. O., Gilbert, R., & Hughes, D. (2017) · Frontiers in Pharmacology · doi:10.3389/fphar.2017.00644 · Cited by 8
“The cost-effectiveness analysis was conducted to accepted methodological standards of trialbased economic evaluations (Ramsey et al., 2015).”
MethodBalal, S., Udoh, A., Pappas, Y., Cook, E., Barton, G., Hassan, A. S., Hayden, K. E., Bourne, R., Ahmad, S., Pardhan, S., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-026770 · Cited by 10
“Economic evaluation Good practice recommendations for cost-effectiveness analyses suggest concentrating on the measurement of large cost drivers, with less focus on resources that are not expected to differ between different treatments.(26) Estima-”
BackgroundAlarid‐Escudero, F., & Kuntz, K. M. (2019) · PharmacoEconomics · doi:10.1007/s40273-019-00859-5 · Cited by 10
Langergaard, A., Mathiasen, K., Søndergaard, J., Sørensen, S. S., Laursen, S. L., Xylander, A. A. P., Lichtenstein, M. B., & Ehlers, L. H. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100513 · Cited by 10
Secher, P. H., Hangaard, S., Kronborg, T., Hæsum, L. K. E., Udsen, F. W., Hejlesen, O. K., & Bender, C. (2022) · Trials · doi:10.1186/s13063-022-06292-y · Cited by 10
Health care utilizations and costs of Campylobacter enteritis in Germany: A claims data analysis
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Ahmed, M., Muhoozi, G. K. M., Atukunda, P., Westerberg, A. C., Iversen, P. O., & Wangen, K. R. (2023) · PLoS ONE · doi:10.1371/journal.pone.0290379 · Cited by 10
“To define precise cost specifications, we followed a few other similar studies [29–32], and the ISPOR recommended guidelines [33].”
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“We followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Cost-Effectiveness Analysis Randomised Clinical Trial taskforce recommendations [14].”
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“These seminal guidelines have since contributed to the development ofmore recent guidelines and detailed methodologies for evaluating health economics published by other institutions and organizations, such as the Third U.S. Preventive Services Task Force (Saha et al., 2001), the International Society for Pharmacoecon…”
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Raman, S., Shafie, A. A., Abraham, M. T., Shim, C. K., Maling, T. H., Rajendran, S., & Cheong, S. C. (2021) · PLoS ONE · doi:10.1371/journal.pone.0251760 · Cited by 10
“While cost data often do not conform to parametric assumptions, the estimates were described in means to ensure robustness and pragmatism in guiding decisions [26].”
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Chan, A., Dang, C., Wisniewski, J., Weng, X., Hynson, E., Zhong, L., & Wilson, L. (2022) · American Journal of Clinical Oncology · doi:10.1097/coc.0000000000000884 · Cited by 10
Arthur, A. J., Aldus, C. F., Sarre, S., Maben, J., Wharrad, H. J., Schneider, J. M., Barton, G., Argyle, E., Clark, A., Nouri, F., et al. (2017) · Health Services and Delivery Research · doi:10.3310/hsdr05100 · Cited by 10
“It is recognised that this can be a large undertaking and it is thereby acknowledged that one should concentrate on large cost drivers which are considered to be potentially related to the intervention in question.(96) With this in mind, we sought to estimate the hospital stay cost for each participant in the study.”
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“The contamination by opportunistic PSA-testing experienced during this trial is more likely to be generalizable to current clinical practice than would ‘no screening’, by providing evidence of the likely impact of organised screening over and above opportunistic testing [19].”
BackgroundMethodInfluentialCost-effectiveness analysis should be mandatory in clinical-effectiveness research
Vijayaraghavan, B. K. T., Willaert, X., & Cuthbertson, B. H. (2019) · Canadian Medical Association Journal · doi:10.1503/cmaj.73298 · Cited by 10
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“The primary outcome was the ICER calculated as the difference in mean costs between the self BACK and control groups divided by the difference between the two groups’ mean QALYs.”
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Lissauer, D. M., Wilson, A., DANIELS, J. P., Middleton, L., Bishop, J. R. B., Hewitt, C., Merriel, A., Weeks, A. D., Mhango, C. G., Mataya, R. H., et al. (2018) · Trials · doi:10.1186/s13063-018-2598-3 · Cited by 9
“An incremental cost-effectiveness analysis will be conducted from a healthcare provider perspective based on the outcome of cost per pelvic infection avoided within 2 weeks from surgery using established health economic methods for multinational trials [18, 19].”
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BackgroundKhan, H. R., Kralj‐Hans, I., Haldar, S., Bahrami, T. T., Clague, J. R., Souza, A. D., Francis, D. P., Hussain, W., Jarman, J. W. E., Jones, D. G., et al. (2018) · Trials · doi:10.1186/s13063-018-2487-9 · Cited by 9
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“We applied different analytic assumptions to determine how downstream costs changed as a result of including only directly attributable costs [39,63] and by varying the costs of PGx testing and costs of statins.”
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“Since all analyses in this paper are based on a trial, we follow current practice and use CEACs as the main tool to summarize the uncertainty about the cost-effectiveness of the intervention (National Institute for Health and Care Excellence, 2013; Ramsey et al., 2015).”
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“To assess uncertainty in the decision to adopt any of the 3 strategies, we constructed a cost-effectiveness acceptability curve (CEAC) (44).”
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“tional Society For Pharmacoeconomics and Outcomes Research guidelines [14].”
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“Best practice methods and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) reporting guidelines were followed as appropriate [23–25].”
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“This is not recommended in good research practice guidelines for cost-effectiveness analysis alongside clinical trials [98].”
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“38 ≤2 11 (24) 4 (13) 3 or more 35 (76) 25 (86) Walker type 1.”
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Mellentin, A. I., Behrendt, S., Bilberg, R., Blankers, M., Folker, M. P., Tarp, K., Uffelmann, J., & Nielsen, A. S. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03122-4 · Cited by 9
Förster, A., Ozer, S., Crocker, T. F., House, A. O., Hewison, J., Roberts, E., Dickerson, J., Carter, G., Hulme, C. T., Fay, M., et al. (2021) · Programme Grants for Applied Research · doi:10.3310/pgfar09030 · Cited by 9
Burden and preference-based quality of life associated with bullying in children
Le, L. K., Chatterton, M. L., Rapee, R. M., Fitzpatrick, S., Bussey, K., Hudson, J. L., Hunt, C. J., CROSS, D. S., Magnus, A., & Mihalopoulos, C. (2021) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01807-5 · Cited by 8
“Therefore, the data were analysed using a generalized linear model (GLM) with and without covariates as recommended by the International Society for Pharmacoeconomics and Outcomes Research guidelines [26].”
MethodMcCutchan, P. K., Yates, B. T., Jobes, D. A., Kerbrat, A. H., & Comtois, K. A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0262592 · Cited by 12
“Multiple imputation using chained equations with predictive mean matching was used to minimize uncertainty related to the replacement of missing data for health services utilization [56].”
MethodDekker, A. R. J., van der Velden, A. W., Luijken, J., Verheij, T. J., & van Giessen, A. (2018) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dky552 · Cited by 8
Cost Effectiveness of Neonatal Resuscitation at 22 Weeks of Gestation
Yieh, L., Dukhovny, D., Zhou, C. G., Gievers, L. L., & Caughey, A. B. (2019) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000003264 · Cited by 8
Schouten, M. J. E., Dekker, J., de Bruijn, T., Ebert, D. D., Koomen, L. E. M., Kosterman, S. L. A., Riper, H. M., Schaub, M. P., Goudriaan, A. E., & Blankers, M. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03222-1 · Cited by 9
“The economic evaluation will be performed in line with the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines [54].”
MethodBackes, C. H., Notestine, J. L., Lamp, J. M., Balough, J. C., Notestine, A. M., Alfred, C. M., Kern, J. M., Stenger, M., Rivera, B. K., Moallem, M., et al. (2019) · Trials · doi:10.1186/s13063-018-3166-6 · Cited by 8
Social recovery therapy for young people with emerging severe mental illness: the Prodigy RCT
Fowler, D., Berry, C., Hodgekins, J., Banerjee, R., Barton, G., Byrne, R., Clarke, T., Fraser, R., Grant, K., Greenwood, K., et al. (2021) · Health Technology Assessment · doi:10.3310/hta25700 · Cited by 7
Ha, I., Kim, E., Lee, S., Lee, Y. J., Song, H. J., Kim, Y., Kim, K., Cho, J., Lee, J., Shin, B., et al. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.896422 · Cited by 7
“The Consolidated Health Economic Evaluation Reporting Standards Statement (CHEERS) checklist (16) is supplemented according to the guidelines (17).”
MethodRwebembera, J., Ndagire, E., Carvalho, N., Webel, A. R., Sable, C., Okello, E., Sarnacki, R., Spaziani, A. M., Atukunda, M., Engelman, D., et al. (2024) · American Heart Journal · doi:10.1016/j.ahj.2024.05.012 · Cited by 7
Freund, J., Smit, F., Lehr, D., Zarski, A., Berking, M., Riper, H. M., Funk, B., Ebert, D. D., & Buntrock, C. (2024) · Journal of Medical Internet Research · doi:10.2196/48481 · Cited by 9
“We carried out and reported the health economic evaluation in accordance with the guidelines of the International Society for Pharmacoeconomics and Outcomes Research [17] and the Consolidated Health Economic Evaluation Reporting Standards statement [18] (more details in Multimedia Appendix 1).”
Economic Evaluations of Music Therapy and Other Music-Based Interventions: A Scoping Review
Riedl, H., Else, B. A., Grünhaus, C., & Holck, U. (2024) · Journal of Music Therapy · doi:10.1093/jmt/thae023 · Cited by 7
Teoh, K. W., Baek, Y., Ademi, Z., & Lee, S. W. H. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.16350 · Cited by 7
Chaudhary, D., Bhat, B., Shields, G., Davies, L. M., Green, J., Verghis, T., Roy, R., Kumar, D., Abhilashi, M. K., Vajaratkar, V. P., et al. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08508-y · Cited by 7
“Current guidelines recommend that economic evaluations alongside clinical trials prioritise high-cost resources and those that are expected to differ between treatment arms [22].”
BackgroundYan, C., Round, J. A., Akpinar, İ., Atwood, C. E., Deuchar, L., Bhutani, M., Leigh, R., & Stickland, M. K. (2023) · PharmacoEconomics - Open · doi:10.1007/s41669-023-00400-7 · Cited by 7
“This model followed the guidelines for cost-effectiveness analysis (CEA) alongside clinical trials by the Professional Society for Health Economics and Outcomes Research (ISPOR) Good Research Practices Task Force [35, 39] and the 2022 Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement [40].”
MethodTornvall, I., Kenny, D., Wubishet, B. L., Russell, A. W., Menon, A., & Comans, T. A. (2023) · Journal of Diabetes Science and Technology · doi:10.1177/19322968231183956 · Cited by 8
“43 However, the purpose of EEs is to inform decision-making for resource-allocation, 44 and when studies fail to report on key items, such as perspective, time horizon, or uncertainty, it could be argued that the economic outcomes are not accurately captured or conveyed.”
Kählke, F., Buntrock, C., Smit, F., Berger, T., Baumeister, H., & Ebert, D. D. (2023) · Depression and Anxiety · doi:10.1155/2023/7912017 · Cited by 9
Karppinen, J. I., Simula, A. S., Holopainen, R., Lausmaa, M., Remes, J., Paukkunen, M., Ussing, K., Booth, N., Ryynänen, K., Koski, T. P. K., et al. (2021) · Health Science Reports · doi:10.1002/hsr2.251 · Cited by 7
“The costs of the training will be considered in the analyses.(36) Finally, we will evaluate the need for presenting treatment effects among specific subgroups (according to, e.”
BackgroundLewkowitz, A. K., Stout, M. J., Carter, E. B., Ware, C. F., Jackson, T. L., D’Sa, V. A., Deoni, S., Odibo, A. O., Gopalakrishnan, R., Liu, J., et al. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.106992 · Cited by 7
The Value of Decision Analytical Modeling in Surgical Research
Tax, C., Govaert, P. H. M., Stommel, M. W. J., Besselink, M. G., Gooszen, H. G., & Rovers, M. M. (2017) · Annals of Surgery · doi:10.1097/sla.0000000000002553 · Cited by 7
Reed, S. D., Li, Y., Dakin, H., Becker, F., Leal, J., Gustavson, S. M., Kartman, B., Wittbrodt, E. T., Mentz, R. J., Pagidipati, N. J., et al. (2019) · Diabetes Care · doi:10.2337/dc19-0950 · Cited by 7
Self-citationRobles‐Zurita, J. A., Briggs, A. H., Rana, D., Quayyum, Z., Oldroyd, K. G., Zeymer, U., Desch, S., de Waha‐Thiele, S., & Thiele, H. (2020) · The European Journal of Health Economics · doi:10.1007/s10198-020-01235-3 · Cited by 8
Self-citationSmith, T., Roberts, M. M., Cho, J., Klimkeit, E., Luckett, T., McCaffrey, N., Kirby, A. C., & Wheatley, J. R. (2020) · Palliative Medicine Reports · doi:10.1089/pmr.2020.0081 · Cited by 7
“Further sensitivity and scenario analyses will be undertaken to examine the effect of varying key parameter estimates on the outcome of the economic evaluation (33).”
BackgroundPrice‐Haywood, E. G., Burton, J. H., Harden-Barrios, J., Bazzano, A. N., Lefante, J. J., Shi, L., & Jamison, R. N. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.106250 · Cited by 7
“All analyses will follow the guidelines on cost-effectiveness analysis conducted alongside clinical trials and economic modeling [33].”
MethodDülsen, P., Barck, K., Daubmann, A., Höller, A., Zeidler, J., Kilian, R., Wiegand‐Grefe, S., & Baumeister, H. (2022) · Frontiers in Digital Health · doi:10.3389/fdgth.2022.816412 · Cited by 9
“For Abbreviations: AOK; Allgemeine Ortskrankenkasse; APOI; Attitudes toward Psychological Online Interventions Questionnaire; AUC; area under the curve; Brief COPE; Brief Coping Orientation to Problems Experienced Inventory; CAMSHRI-EU; Children and Adolescent Mental Health Services Receipt Inventory; CBCL; Child Beha…”
MethodA Cost-Utility Analysis of the Syncope: Pacing or Recording in The Later Years (SPRITELY) Trial
Hofmeister, M., Sheldon, R. S., Spackman, E., Raj, S. R., Talajic, M. R., Becker, G., Essebag, V., Ritchie, D., Morillo, C. A., Krahn, A. D., et al. (2022) · CJC Open · doi:10.1016/j.cjco.2022.03.009 · Cited by 7
Commentary: Demon$trating (Our) Value
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Incorporating healthcare access and equity in economic evaluations: a scoping review of guidelines
Dawkins, B., Shinkins, B., Ensor, T., Jayne, D. G., & Meads, D. M. (2024) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462324000618 · Cited by 8
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Tarride, J., Blackhouse, G., Rochwerg, B., Fox-Robichaud, A., Ball, I. M., Burns, K. E., Seely, A., Muscedere, J., Berney, S., Pastva, A., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.29399 · Cited by 8
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Metadata
- Authors
- Ramsey, S. D., Willke, R. J., Glick, H., Reed, S. D., Augustovski, F., Jonsson, B., Briggs, A., & Sullivan, S. D.
- Affiliations
- University of Washington (US)
- Pfizer (United States) (US)
- University of Pennsylvania (US)
- Duke University (US)
- Universidad de Buenos Aires (AR)
- University of Glasgow (GB)
- Corresponding author
- Ramsey, Scott D.
- ORCID
- Venue
- Value in Health
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 18
- Issue
- 2
- Pages
- 161-172
- ISSN
- 1098-3015 (ISSN-L)
- OpenAlex
- W2139814250
- Cited by
- 811
- References
- 184
- Citations by year
- 2026: 58 · 2025: 75 · 2024: 90 · 2023: 80 · 2022: 100 · 2021: 103 · 2020: 88 · 2019: 65 · 2018: 50 · 2017: 57 · 2016: 37 · 2015: 6
- FWCI
- 17.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Value in Health (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Keywords
- cost-effectiveness analysis, clinical trials, economic evaluation, trial design, health care utilization, health utility, intention-to-treat analysis, subgroup analysis, uncertainty characterization, reporting guidelines, reimbursement decisions, healthcare resource allocation
- MeSH terms
- Cost-Benefit Analysis, Health Policy, Health Services Research, Humans, Randomized Controlled Trials as Topic, Advisory Committees, Research Report
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