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Cover of Best Practices for Conducting Economic Evaluations in Health Care: A Systematic Review of Quality Assessment Tools

Best Practices for Conducting Economic Evaluations in Health Care: A Systematic Review of Quality Assessment Tools

Methods Research Reports

Investigators: , PhD, , MS, , BS, , PhD, , MD, PhD, , MD, MPH, and , PhD.

Author Information
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 12(13)-EHC132-EF

Structured Abstract


This report describes the strengths and weaknesses of checklists that have been used to evaluate best practices for conducting and reporting on economic evaluations in health care. We defined checklists as any original listing of specific items that the authors recommended be addressed in the conduct or reporting of an economic evaluation. We focused on how checklists define: (1) the criteria for judging that an economic evaluation is of sufficiently high quality to be useful; (2) the importance of different aspects of the evaluation; and (3) the extent to which high quality with respect to one aspect of an evaluation can compensate for lower quality with respect to another aspect of the evaluation.


A systematic approach was taken to search the literature through January 2012 for articles relevant to economic evaluations, outcomes, and guidelines for the decisionmaker. The following electronic databases were searched using similar search strategies: MEDLINE, EconLit, CINAHL, Embase, and ISI Web of Science. References of relevant reviews were searched for applicable articles. Experts were queried to ensure that all pertinent articles were included.


Ten peer-reviewed journal articles reported on an original checklist for assessing an economic evaluation. The first was published in 1992, and the last was published in 2011. The number of items in the checklists ranged from 11 to 57. One item, perspective, was a criterion in all 10 of the checklists. Eleven other criteria were included in seven to nine of the checklists: description of the target population, choice of alternatives, study question, study design, measurement, valuation, outcome identification, outcome measurement, adjustment for time variation, sensitivity and uncertainties, presentation of results, generalizability, and incremental analysis. Four of the checklists had evidence of excellent test-retest reliability, but none of the checklists had consistent evidence of excellent inter-rater reliability in two or more studies. Only three of the checklists had evidence of excellent criterion validity, based on comparisons between checklists or comparisons with ratings of experts in health economics.


Several well-developed checklists exist for investigators, reviewers, and journal editors to use in efforts to ensure that economic evaluations and eventual systematic reviews of economic evaluations will be more informative and transparent. The choice of an appropriate checklist should be made with the understanding that quality assessment tools will continue to evolve over time and must improve in reliability and validity for all decisionmakers.


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:

Walker DG, Wilson RF, Sharma R, Bridges J, Niessen L, Bass EB, Frick K. Best Practices for Conducting Economic Evaluations in Health Care: A Systematic Review of Quality Assessment Tools. Methods Research Report. (Prepared by Johns Hopkins University Evidence-based Practice Center under contract No. 290-2007-10061-I.) AHRQ Publication No. 12(13)-EHC132-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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Bookshelf ID: NBK114545PMID: 23230577


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