Issues in the incorporation of economic perspectives and evidence into Cochrane reviews

Abstract

BackgroundMethods for systematic reviews of the effects of health interventions have focused mainly on addressing the question of 'What works?’ or 'Is this intervention effective in achieving one or more specific outcomes?’ Addressing the question 'Is it worth it given the resources available?’ has received less attention. This latter question can be addressed by applying an economic lens to the systematic review process.This paper reflects on the value and desire for the consideration by end users for coverage of an economic perspective in a Cochrane review and outlines two potential approaches and future directions.MethodsTwo frameworks to guide review authors who are seeking to include an economic perspective are outlined. The first involves conducting a full systematic review of economic evaluations that is integrated into a review of intervention effects. The second involves developing a brief economic commentary. The two approaches share a set of common stages but allow the tailoring of the economic component of the Cochrane review to the skills and resources available to the review team.ResultsThe number of studies using the methods outlined in the paper is limited, and further examples are needed both to explore the value of these approaches and to further develop them. The rate of progress will hinge on the organisational leadership, capacity and resources available to the CCEMG, author teams and other Cochrane entities. Particular methodological challenges to overcome relate to understanding the key economic trade-offs and casual relationships for a given decision problem and informing the development of evaluations designed to support local decision-makers.ConclusionsMethods for incorporating economic perspectives and evidence into Cochrane intervention reviews are established. Their role is not to provide a precise estimate of 'cost-effectiveness’ but rather to help end-users of Cochrane reviews to determine the implications of the economic components of reviews for their own specific decisions.

How to prepare a systematic review of economic evaluations for informing evidence-based healthcare decisions: a five-step approach (part 1/3)

“…Accordingly, all relevant findings of the studies need to be presented in detail in summary tables and also summarized in the text [1,7,11]. Ranking the studies by means of a league table based on the costs per QALY can be very useful [79].…”

“…When those decisions are highly focused on evidence-based methodologies that consider only one dimension of relevant evidence (i.e. whether the intervention works), this may contribute to inefficient policy and practice decisions [1]. Systematic reviews (SRs) are the reference standard for synthesizing data because of their methodological rigor [2].…”

Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention among 12- to 15-Year-Olds in Sweden

“…and have not aimed to determine whether the intervention is worth performing according to the available resources. It is therefore important to incorporate economic perspectives in evaluations of health interventions [Shemilt et al, 2013]. When implementing a guideline, its cost-effectiveness has to be taken into consideration.…”

The crime, mental health, and economic impacts of prearrest diversion of people with mental health problems: A systematic review

“…All included effect studies were critically appraised using an adapted version of a quality assessment checklist for quantitative intervention studies (NICE, 2012;Waddington & Hombrados, 2012;Baird, Ferreira, Özler, & Woolcock, 2013). The synthesis of economic data drew on methods for an economic commentary (Shemilt et al, 2011;Shemilt et al, 2013).…”