Changes in cost-effectiveness over time

The case of epoetin alfa for renal replacement therapy patients in the UK

Edit Remák*, J. Hutton, M. Jones, M. Zagari

*Corresponding author for this work

Research output: Contribution to journalArticle

26 Citations (Scopus)


We analysed the factors influencing cost-effectiveness of a health care intervention over time using economic evaluations of erythropoietin as a case study. The analytical framework of a study conducted in 1990 was used to revisit the cost-effectiveness of erythropoietin. Study variables were updated to 2000 using meta-analysis, published sources, and expert opinion. After 10 years of further experience with the use of erythropoietin the cost-effectiveness ratio now falls within the range considered acceptable in the UK. The analysis shows that the vast proportion of the reduction in the cost-effectiveness ratio achieved since 1990 results from reductions in the dose and price of erythropoietin. True cost-effectiveness of a treatment can change over time, and early analysis can reach incorrect conclusions because of data deficiencies. The existence of a body such as NICE might have delayed the widespread adoption of erythropoietin in the UK, but the higher standards of clinical and economic evidence demanded by such a body might have expedited the appropriate pricing, dosage, and hence utilisation of the treatment.

Original languageEnglish
Pages (from-to)115-121
Number of pages7
JournalEuropean Journal of Health Economics
Issue number2
Publication statusPublished - 2003
Externally publishedYes


  • Cost effectiveness
  • Economic evaluation
  • Erythropoietin
  • Renal replacement therapy

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