How has heterogeneity been addressed in US cost utility analyses, and what are the methods available to incorporate it? New research underlines the importance of accounting for differences between patients when assessing the value of healthcare.
Many patients may not receive optimal treatment because payers base coverage decisions on population averages for treatment benefits, harms and costs. Comparative economic analyses that do not account for heterogeneity, i.e. differences in outcomes arising from systematic variation in factors like patient characteristics, insurer coverage terms and provider practices, will provide inaccurate estimates of the value of treatments and can lead to denial of appropriate care to patients whose needs diverge from population norms.
This study assessed the methods to account for heterogeneity and examined the extent to which, and how, it has been addressed in US cost-utility studies. Implications of ignoring sources of heterogeneity are discussed and recommendations to encourage the thorough consideration of heterogeneity in US comparative economic evaluations are provided.
This research was funded by Johnson & Johnson Innovative Medicine and conducted in collaboration with Michael Willis and Andreas Nilsson, employees of the Swedish Institute for Health Economics. For full details on the study design, methods and limitations, see: Willis MS, et al. A review of heterogeneity in comparative economic analysis, with specific considerations for the decentralized US setting and patient-centered care. Pharmacoeconomics. 2025. Advance online publication. doi: 10.1007/s40273-025-01478-z.