Author's Clinical Specialty: A Competing Interest in Economic Analysis of Surgical Interventions, Reality or Fiction?.
well-developed literature suggests that financial conflicts of interest are associated
with results reported in published health economic analyses. This study investigates the
association between the clinical specialty of publishing authors and the favorability of
reported incremental cost effectiveness ratios (ICERs). We evaluated surgical
interventions catalogued in the Tufts Me... read moredical Center Cost Effectiveness Analysis (CEA)
Registry (www.cearegistry.com). We used the Tufts CEA Registry, a comprehensive database
of cost-utility analyses that have been performed for a wide variety of diseases,
conditions and treatment options. Eligible studies were articles and ratios labeled as
"surgical" studies between 1976 and 2011. Logistic regression models were used to
examine the multivariate relationship between the primary outcome (favorable ICER) and
the primary author's clinical specialty while controlling for confounders, including the
source of funding for the published analysis and the type of treatment option to which
the intervention was compared. Our primary results showed that CEAs comparing surgical
interventions with alternative treatment options using the $50,000 per QALY benchmark
did not show a significant association between primary author being a surgeon and ICER
favorability (adjusted OR= 1.25, 95% CI= 0.78- 1.99, p=0.38). When compared relative to
the weighted median ICER in our sample there was a strong trend to producing favorable
ICER when the primary author is a surgeon (OR= 1.60, 95% CI=1.06 - 2.40, p= 0.02 and
adjusted OR= 1.50, 95% CI= 0.99- 2.30, p= 0.06). The "surgeon" effect was more evident
with the increased proportion of surgeons per article (OR =2.43, CI=1.36 - 4.41, p =
0.003, adjusted OR= 2.22, CI=1.22-4.09, p = 0.01). Our study is the first to show an
evidence that non-financial competing interests may represent an important source of
bias that has not yet been systematically addressed. Understanding this source of bias
may guide stakeholders when utilizing this
Thesis (M.S.)--Tufts University, 2013.
Submitted to the Dept. of Clinical & Translational Science.
Advisors: Joshua Cohen, and David Kent.
Committee: Joshua Cohen, Robin Ruthazer, and David Kent.
Keywords: Surgery, Health care management, and Economics.read less