Conducting economic evaluations alongside multinational studies presents a range of diverse challenges which have contributed to a lack of consensus on how they should be approached particularly because of the difficulties of resolving between country differences. This thesis examines the implications of conducting economic evaluation alongside multinational studies and (i) explores different approaches to obtaining unit costs; (ii) investigates the impact of using different tariffs to value EQ-5D health state descriptions; and (iii) provides a systematic comparison of the pooled and split approaches to economic evaluation alongside multinational trials. This study documents challenges that have been reported in published studies and makes recommendations to help researchers undertake economic evaluations alongside multinational studies.
Results indicate that the main challenge related to dealing with the differences between countries. Collecting unit cost data in all participating countries proved a difficult task, but was most effectively done by collaborating/direct contact with project partners and researchers/health economists from participating countries. Applying different EQ-5D value sets within the context of multinational trials did not make a difference to the conclusions in most cases. However, it is recommended that results from various tariffs are compared within sensitivity analysis. This study also showed that the choice of whether to pool or split the data can lead to different conclusions and recommendations about the cost-effectiveness of interventions. The culmination of this work is a 10 point checklist to guide good practice in the design, conduct and analysis of multinational economic evaluation studies and also highlights many areas where further research is needed. The work provides researchers, policy makers and stakeholders with additional insight into the economic analysis of multinational studies
