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Usefulness of Economic Evaluation Data in Systematic Reviews of Evidence
Methods Research Reports
Investigators: Kevin Frick, PhD, Louis Neissen, MD, PhD, John Bridges, PhD, Damian Walker, PhD, Renee F Wilson, MSc, and Eric B Bass, MD, MPH.
Author Information and AffiliationsStructured Abstract
Background:
Systematic reviews play an important role in improving understanding of the comparative effectiveness of medical interventions, but economic data have not usually been included despite their importance in determining the value of interventions. This paper addresses the usefulness of incorporating economic evaluation data into systematic reviews of medical interventions.
Methods:
A consensus process including outside experts was used to develop a conceptual framework for including economic evidence alongside systematic reviews, and to define tradeoffs in presenting economic data. The framework was based on five questions: (1) Why are stakeholders interested in economic evaluation data? (2) When should economic evaluation data be requested in a systematic review? (3) Who is interested in economic evaluation data? (4) What economic evidence is of interest? and (5) How should the economic evaluation be conducted?
Results:
Decisions about inclusion of economic data in systematic reviews should be based on the magnitude of the incremental cost, magnitude of the incremental effect, and the probability that economic evidence will change a decision. Economic data should be given a high priority when evidence indicates a small effect at a high level of expenditure with a high probability of influencing a decision. All stakeholders (including public and private insurers) should be interested in economic data and the perspectives of patients, providers, and manufacturers because patients and providers together determine the demand for care and manufacturers determine the supply. Economic data are of interest for decisions at many levels, including decisions about approval and monitoring of services, formulary inclusion, insurance coverage, reimbursement rate, preferred practice guideline, technology adoption or nonadoption, or clinical management. Economic data of interest include information that contributes directly to cost-effectiveness analyses, as well as data on productivity changes related to a disease or its treatment, basic price data, and data on responses to price changes. When it is appropriate to include economic data in a systematic review, it may be sufficient to review available economic analyses, but it may be necessary to perform a new economic evaluation if previous evaluations are inadequate (absent, low quality, or very heterogeneous) or if important new data are available.
Conclusion:
The approach to gathering economic data alongside a systematic review of evidence will be governed by the decision context and the need for a new economic evaluation consistent with the other findings of the systematic review.
Contents
- Preface
- Acknowledgments
- Technical Expert Panel
- Peer Reviewers
- Introduction
- Methods
- Results
- Decisionmaking Contexts—Why Are Stakeholders Interested in Economic Evaluation Data?
- When Should Economic Evaluation Data Be Requested in a Systematic Review?
- Stakeholders—Who Is Interested in Economic Evaluation Data?
- Economic Components—What Economic Evidence Is of Interest?
- How Should the Economic Evaluation Be Conducted? Should the Economic Evaluation Be a Summary of Existing Evaluations or New Evaluations With Inputs Consistent With the Remainder of the Systematic Review?
- Discussion
- References
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10061-I. Prepared by: The Johns Hopkins University Evidence-based Practice Center, Baltimore, MD
Suggested citation:
Frick K, Neissen L, Bridges J, Walker D, Wilson RF, Bass EB. Usefulness of Economic Evaluation Data in Systematic Reviews of Evidence. Methods Research Report. (Prepared by The Johns Hopkins University Evidence-based Practice Center under Contract No. 290-2007-10061-I.) AHRQ Publication No. 12(13)-EHC114-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by The Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10061-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
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