Development and Validation of a Grading System for the Quality of Cost-Effectiveness Studies

Chiou, Chiun–Fang; Hay, Joel W.; Wallace, Joel; Bloom, Bernard S.; Neumann, Peter J.; Sullivan, Sean D.; Yu, Hsing-Ting; Keeler, Emmett B.; Henning, James M.; Ofman, Joshua J.

doi:10.1097/00005650-200301000-00007

Cited by 256 publications

(235 citation statements)

References 28 publications

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“…17 The BMJ tool allows a detailed qualitative assessment, whereas the QHES tool provides an overall score for each study. Quality assessment of all included studies was performed independently by two researchers (M.D.M., N.P.).…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

Which Lynch syndrome screening programs could be implemented in the “real world”? A systematic review of economic evaluations

Marco

D’Andrea

Panić

et al. 2018

Genetics in Medicine

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Purpose: Lynch syndrome (LS) screening can significantly reduce cancer morbidity and mortality in mutation carriers. Our aim was to identify cost-effective LS screening programs that can be implemented in the "real world."Methods: We performed a systematic review of full economic evaluations of genetic screening for LS in different target populations; health outcomes were estimated in life-years gained or quality-adjusted life-years.Results: Overall, 20 studies were included in the systematic review. Based on the study populations, we identified six categories of LS screening program: colorectal cancer (CRC)-based, endometrial cancer-based, general population-based, LS family registry-based, cascade testing-based, and genetics clinic-based screening programs. We performed an in-depth analysis of CRC-based LS programs, classifying them into three additional subcategories: universal, age-targeted, and selective. In five studies, universal programs based on immunohistochemistry, either alone or in combination with the BRAF test, were cost-effective compared with no screening, while in two studies age-targeted programs with a cutoff of 70 years were cost-effective when compared with agetargeted programs with lower age thresholds.Conclusion: Universal or o70 years-age-targeted CRC-based LS screening programs are cost-effective and should be implemented in the "real world." Genet Med advance online publication 4 January 2018Key Words: colorectal cancer; cost-effectiveness; Lynch syndrome; screening program; systematic review INTRODUCTIONLynch syndrome (LS) is the most common cause of inherited colorectal cancer (CRC), accounting for about 3% of newly diagnosed cases, and results from a mutation in one of the DNA mismatch repair (MMR) genes (MLH1, MSH2, MSH6, and PMS2). As LS is associated with an increased risk of colorectal, endometrial, and other cancers, it is important to identify both the probands and their family members. 1 In 2009, the Evaluation of Genomic Applications in Practice and Prevention Working Group recommended testing for LS in individuals with newly diagnosed CRC to reduce cancer morbidity and mortality in relatives. 2 The working group declared that there is a moderate certainty that this would provide moderate population benefit, but it did not recommend a specific genetic testing strategy among the several examined, nor did it deal with implementation issues. 2 Thereafter the US Department of Health and Human Services adopted the following as a Healthy People 2020 developmental objective: 3 "Increase the proportion of persons with newly diagnosed colorectal cancer who receive genetic testing to identify Lynch syndrome (or familial colorectal cancer syndromes)."Although genomic information has the potential to improve the delivery of patient-centered care through tailored preventive, diagnostic, and treatment strategies, there is a considerable gap between discoveries in genomics research and the translation of these findings into genetic services that benefit patients. 4,5 A previous study highl...

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Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

Which Lynch syndrome screening programs could be implemented in the “real world”? A systematic review of economic evaluations

Marco

D’Andrea

Panić

et al. 2018

Genetics in Medicine

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“…However, it does not provide information on the validity and appropriateness of the data used in the analyses. To evaluate the validity of this instrument, we performed a sensitivity analysis using the previously validated Quality of Health Economic Studies (QHES) instrument (see Appendix 2, available online at www.cmaj.ca/cgi/content/full/176/2/199/DC1) 13,14 which includes measures of the quality of the different input variables but is therefore also potentially more sensitive to Excluded n = 3…”

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confidence: 99%

The cost-effectiveness of drug-eluting stents: a systematic review

Ligthart¹,

Vlemmix²,

Dendukuri³

et al. 2007

Canadian Medical Association Journal

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D rug-eluting stents became commercially available in 2002 in Europe and Canada and in 2003 in the United States 1 and are now widely used in the treatment of coronary artery disease. Restenosis of the target lesion has been the "Achilles heel" of percutaneous coronary interventions (PCIs), with 15%-40% of patients in randomized controlled trials (RCTs) who received bare-metal stents needing repeat revascularization within 6 months. 2 Numerous RCTs 3-6 and meta-analyses 7 have shown that the use of drug-eluting stents reduces this risk by an estimated 83%. Given their comparable short-term safety profiles, drugeluting stents have been seen as an attractive clinical alternative to bare-metal stents. However, no differences in deaths or myocardial infarctions have been seen between study groups receiving either type of stent. 7 Furthermore, the absolute reductions in the rate of repeat revascularization observed with drug-eluting stents may be overestimated, owing to protocoldriven angiographic follow-up in RCTs. 8,9 Nevertheless, the clinical benefits of fewer repeat revascularizations with drugeluting stents and improved quality of life, even if ephemeral, are enticing.Because drug-eluting stents are considerably more expensive than bare-metal stents, with an estimated world market of $6 billion annually, 10 cost-effectiveness analyses may help decision-makers assess the value of this additional investment. Although many cost-effectiveness studies have been carried out, they have arrived at different conclusions despite using a relatively constant measure of the efficacy of drugeluting stents. By systematically reviewing all published costeffectiveness analyses, we attempt to understand the determinants of the different conclusions. MethodsWe performed an extensive literature search for all Englishlanguage cost-effectiveness studies published between Jan. 1, 2000, and July 31, 2006, that assessed the impact of costs of drug-eluting stents compared with bare-metal stents on a health care system. We decided not to distinguish between the different models of drug-eluting stents because, although sirolimus-eluting stents appear to be more clinically effective than paclitaxel-eluting ones, 11 both are extensively used in clinical practice and because the prices of drug-eluting stents

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“…and Z.M.) using the Quality of Health Economic Studies (QHES) instrument developed by Chiou et al 10 This grading system has 16 criteria, each of which is associated with a specific value, and the total quality scores can range from 0 to 100. Before grading, both reviewers reached consensus on the interpretation of the criteria.…”

Section: Methodsmentioning

confidence: 99%

“…10 The correlation between the two reviewers' scores is 0.77. The mean quality score for the reviewed studies was 89.8 with a range of 41-100.…”

Section: Quality Of Included Studiesmentioning

confidence: 97%

A review of economic evaluations of genetic testing services and interventions (2004–2009)

Djalalov

Musa

Mendelson³

et al. 2011

Genetics in Medicine

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Abstract:To review economic evaluations of genetic interventions published between 2004 and 2009 and assess the quality of the identified studies, we searched for economic evaluations of genetic testing and interventions published between 2004 and 2009. Studies that met inclusion criteria were reviewed and their quality then assessed using a validated instrument-the Quality of Health Economic Studies. Of 54 articles identified, 26 met study criteria and were included in the review. These studies span a number of clinical indications, genetic tests, and interventions, but the majority (92%) focuses on genetic interventions for preventive screening and increasing treatment efficacy. The mean quality score for the reviewed studies was 89.8. Comparison of the quality of different study types revealed that cost-utility studies and studies that used a combined decision tree and Markov model had the highest mean quality scores. Clear statements regarding bias, funding source, and study perspective were commonly lacking in the reviewed studies. Although the reviewed studies were of fairly high quality, we found Quality of Health Economic Studies methodology for grading the quality of economic evaluations challenging and observed no statistically significant improvement in quality of studies between the periods

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Development and Validation of a Grading System for the Quality of Cost-Effectiveness Studies

Abstract: The instrument appears to be simple, internally consistent, and valid for measuring the perceived quality of CE studies. Applicability for use in clinical and resource allocation decision-making deserves further study.

Cited by 256 publications

References 28 publications

Which Lynch syndrome screening programs could be implemented in the “real world”? A systematic review of economic evaluations

Which Lynch syndrome screening programs could be implemented in the “real world”? A systematic review of economic evaluations

The cost-effectiveness of drug-eluting stents: a systematic review

A review of economic evaluations of genetic testing services and interventions (2004–2009)

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