Bring Out Your Dead: A Review of the Cost Minimisation Approach in Health Technology Assessment Submissions to the Australian Pharmaceutical Benefits Advisory Committee

Zachary Tirrell (), Alicia Norman, Martin Hoyle, Sean Lybrand and Bonny Parkinson
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Zachary Tirrell: Macquarie University, Macquarie University Centre for the Health Economy
Alicia Norman: Macquarie University, Macquarie University Centre for the Health Economy
Martin Hoyle: Macquarie University, Macquarie University Centre for the Health Economy
Sean Lybrand: Macquarie University, Macquarie University Centre for the Health Economy
Bonny Parkinson: Macquarie University, Macquarie University Centre for the Health Economy

PharmacoEconomics, 2024, vol. 42, issue 11, No 10, 1287-1300

Abstract: Abstract Objectives Published literature has levied criticism against the cost-minimisation analysis (CMA) approach to economic evaluation over the past two decades, with multiple papers declaring its ‘death’. However, since introducing the requirements for economic evaluations as part of health technology (HTA) decision-making in 1992, the cost-minimisation analysis (CMA) approach has been widely used to inform recommendations about the public subsidy of medicines in Australia. This research aimed to highlight the breadth of use of CMA in Australia and assess the influence of preconditions for the approach on subsidy recommendations Methods Relevant information was extracted from Public Summary Documents of Pharmaceutical Benefits Advisory Committee (PBAC) meetings in Australia considering submissions for the subsidy of medicines that included a CMA and were assessed between July 2005 and December 2022. A generalised linear model was used to explore the relationship between whether medicines were recommended and variables that reflected the primary preconditions for using CMA set out in the published PBAC Methodology Guidelines. Other control variables were selected through the Bolasso Method. Subgroup analysis was undertaken which replicated this modelling process. Results While the potential for inferior safety or efficacy reduced the likelihood of recommendation (p

Date: 2024
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DOI: 10.1007/s40273-024-01420-9

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