Country specific cost comparisons from multinational clinical trials using empirical Bayesian shrinkage estimation: the Canadian ASSENT-3 economic analysis

Health Econ. 2005 Apr;14(4):327-38. doi: 10.1002/hec.969.


The growing number of multinational clinical trials in which patient-level health care resource data are collected have raised the issue of which is the best approach for making inference for individual countries with respect to the between-treatment difference in mean cost. We describe and discuss the relative merits of three approaches. The first uses the random effects pooled estimate from all countries to estimate the difference for any particular country. The second approach estimates the difference using only the data from the specific country in question. Using empirical Bayes estimation a third approach estimates the country-specific difference using a variance-weighted linear sum of the estimates provided by the other two approaches. The approaches are illustrated and compared using the data from the ASSENT-3 trial.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abciximab
  • Antibodies, Monoclonal / economics
  • Antibodies, Monoclonal / therapeutic use
  • Anticoagulants / economics
  • Anticoagulants / therapeutic use
  • Bayes Theorem
  • Enoxaparin / economics
  • Enoxaparin / therapeutic use
  • Health Care Costs / statistics & numerical data*
  • Heparin / economics
  • Heparin / therapeutic use
  • Humans
  • Immunoglobulin Fab Fragments / economics
  • Immunoglobulin Fab Fragments / therapeutic use
  • International Cooperation*
  • Multicenter Studies as Topic
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / economics
  • Randomized Controlled Trials as Topic / economics*
  • Randomized Controlled Trials as Topic / statistics & numerical data*


  • Antibodies, Monoclonal
  • Anticoagulants
  • Enoxaparin
  • Immunoglobulin Fab Fragments
  • Heparin
  • Abciximab