Story at a glance
- Insurance companies tend to favor drugs and medical devices that offer the most benefit to patients at the cheapest price.
- This could result in manufacturer bias when conducting cost effectiveness analyses, because profits increase when more insurance companies cover their innovation.
- In a new review, researchers found industry-sponsored analyses tended to favor pricer drugs compared with those conducted by independent third parties, highlighting systemic bias in these practices.
Cost effectiveness analysis (CEA) studies can be helpful for both patients when deciding which drug to take, and insurance companies when deciding which drugs to include on their formularies.
While in theory CEAs seem like an effective tool for increasing efficiency and affordability in health care, a new study published in The BMJ revealed “significant, systemic, and sponsorship bias” among CEAs conducted by drugmakers as opposed to independent third parties.
Researchers from universities in Canada and China used data from the Tufts Cost-Effectiveness Analysis Registry to assess CEAs published between 1976 and 2021. All studies that included incremental cost effectiveness ratios (ICERs) using quality adjusted life years were considered for inclusion.
Separating analyses that were sponsored by industry (around 30 percent) from those that were not, data showed drugmaker-funded studies were more likely to publish ICERs below the $50,000, $100,000 and $150,000 thresholds, compared with independent studies.
In other words, industry-sponsored CEAs were more likely to report their interventions were cost-effective than non-sponsored studies.
Seventy percent of all studies published marked ICERs as below $50,000 and only 20 percent found them to exceed $100,000, “indicating a publication bias against CEAs with unfavorable results based on commonly used standards of cost effectiveness,” authors wrote.
Based on these data, insurance companies may be more inclined to use independent studies as guidance when assessing cost-effectiveness of certain drugs, they said.
New drugs or devices can generate much higher profits when covered by insurance plans than those not covered, researchers explained. However, this economic tie between industry and insurance coverage approval could result in sponsorship bias.
CEAs can be conducted on medical devices, pharmaceuticals, and other health interventions. But in the current study, CEAs on drugs made up the majority of industry-sponsored studies, with one of the largest sponsorship biases seen in drug analyses.
Because wealthier countries have the resources and capacity for independent parties to conduct CEAs, other countries may have to rely on published industry-sponsored analyses to make coverage decisions.
Taken in a broader context, these findings suggest sponsorship bias could lead to higher drug prices in low- and middle-income nations with less resources to pay for health care.
Published on Jun. 23, 2022