Cost-effectiveness analysis using data from multinational trials: the use of bivariate hierarchical modeling. Med Decis Making

Health care economic evaluation studies benefitconsiderably from access to individual patient data (IPD) from randomized controlled trials (RCTs).1 In the context of some health care interventions—in particular, pharmaceuticals—RCTs are often multina-tional in design. Such studies offer several advantages over single-country counterparts. These include the opportunity to reach rapidly the required target sam-ple size and meeting the needs of regulatory agencies in different jurisdictions. Furthermore, because these studies enroll patients from a wide range of countries, multinational trials are thought to have the potential to increase the geographical generalizability of clini-cal and cost-effectiveness estimates.2 However, 2 sets of arguments suggest that this view-point may not be totally defensible. The first relates t