Does Relative Effectiveness Vary Across Europe?

At the Spanish Health Economics Association (AES) conference in May 2011, OHE’s Ruth Puig Peiró discussed a recent OHE study that reviewed the available literature on variations in medicines’ efficacy and effectiveness across countries.

The desire to use limited health care resources wisely has driven interest in understanding the relative or comparative effectiveness of medicines.  In the Europe Union, discussions continue about whether a pan-European assessment of relative cost-effectiveness is possible and/or desirable.  An enduring issue is whether variations among countries are great enough to create important differences in the effectiveness of treatment.  Factors include, for example, patients’ characteristics, differences in clinical practice, and other variations at the institutional and national levels that affect both underlying population health and access to care.

At the Spanish Health Economics Association (AES) conference in May 2011, OHE’s Ruth Puig Peiró discussed a recent OHE study that reviewed the available literature on variations in medicines’ efficacy and effectiveness across countries.  Considered were clinical trial studies and cost effectiveness studies published in English from 2000 to May 2010.  Of the eight studies that qualified, most reported results of relative efficacy from clinical trials, rather than the effectiveness of the treatment in actual clinical practice.  A table of the studies is available in the presentation.

The authors note that clinical trials are designed to demonstrate efficacy; they are not intended to tease out differences across countries, but to show overall treatment effects.  The underlying assumption is that relative efficacy does not vary substantially from one country to another.  Although some such research notes that variations do occur, these rarely are quantified by country.

No studies were found that examine differences in effectiveness across countries – i.e., how well a treatment performs in the real world.  The authors suggest that collecting and analysing reliable and comparable registry data would be one means of producing analyses for this purpose, but recognise that this would be a complex and expensive undertaking. Download Puig Peiró, R. Relative effectiveness across Europe: Do Member States diverge in clinical outcomes from treatment? Presentation at the Asociación de Economia de la Salud. Mallorca, Spain. 5 May 2011.

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