A systematic review and critical analysis of cost-effectiveness studies for coronary artery disease treatment

Abstract

Background: Cardiovascular disease remains the primary cause of death among Australians, despite dramatic improvements in overall cardiovascular health since the 1980s. Treating cardiovascular disease continues to place a significant economic strain on the Australian health care system, with direct healthcare costs exceeding those of any other disease. Coronary artery disease accounts for nearly one third of these costs and spending continues to rise. A range of treatments is available for coronary artery disease yet evidence of cost-effectiveness is missing, particularly for the Australian context. Cost-effectiveness evidence can signal waste and inefficiency and so is essential for an efficient allocation of healthcare resources. Methods: We used systematic review methods to search the literature across several electronic databases for economic evaluations of treatments for stable coronary artery disease. We critically appraised the literature found in searches, both against the CHEERS statement for quality reporting of economic evaluations and in terms of its usefulness for policy and decision-makers. Results: We retrieved a total of 308 references, 229 once duplicates were removed. Of these, 26 were excluded as they were not full papers (letters, editorials etc.), 55 were review papers, 50 were not cost-effectiveness analyses and 93 related to a highly specific patient sub-group or did not consider all treatment options. This left five papers to be reviewed in full. Conclusions: The current cost-effectiveness evidence does not support the increased use of PCI that has been seen in Australia and internationally. Due to problems with accessibility, clarity and relevance to policy and decision-makers, some otherwise very scientifically rigorous analyses have failed to generate any policy changes.

Economic Evaluation of Long-Term Survivorship Care for Cancer Patients in OECD Countries: A Systematic Review for Decision-Makers

“…The quality assessment for each study is presented in Appendix D . While examining the analysis type and findings according to the CHEERS checklist is performed to assess the quality of reporting [ 17 ], checking the usefulness to decision-makers is arguably of greater importance [ 9 ]. Consequently, we used an adapted version of the approach that has been used in previous systematic reviews to assess a paper’s usefulness to decision-makers [ 8 , 9 ].…”

“…While examining the analysis type and findings according to the CHEERS checklist is performed to assess the quality of reporting [ 17 ], checking the usefulness to decision-makers is arguably of greater importance [ 9 ]. Consequently, we used an adapted version of the approach that has been used in previous systematic reviews to assess a paper’s usefulness to decision-makers [ 8 , 9 ]. This approach assesses usefulness for decision-makers based on the reporting of effectiveness and cost outcomes and the uncertainty associated with such outcomes.…”

“…Strong: “Yes” to all items; Moderate: “No” or “NA” or “Not conducted” to one or two items; Limited: “No” or “NA” or “Not conducted” to more than two items. * Adapted from Cheng et al [ 8 ] and McCreanor et al [ 9 ] with copyright permission for use obtained from the corresponding authors. ICER—Incremental Cost-Effectiveness Ratio; OW—One-Way; MW—Multi-Way; PSA—Probabilistic Sensitivity Analysis; TA—Threshold Analysis; SA—Scenario Analysis.…”

“…Despite increased interest and reliance on economic evidence in healthcare, decision-makers need to understand the potential impact of acting on such evidence and how such actions might influence clinical outcomes and costs. Healthcare decision-makers require economic evidence to be high-quality, useful for informing resource allocation decisions, applicable to the real-world healthcare setting and easily translated into practice [ 8 , 9 ].…”

“…Systematic reviews of economic evaluations relating to long-term cancer survivorship exist, but they do not focus on the usefulness of reported evidence for decision-making. One review focuses on economic evaluations of follow-up cancer care treatment [ 9 ], while another was conducted to identify analyses that have been included in guidance on cancer follow-up by UK government agencies and aimed to assess the relevance to the UK setting [ 10 ]. The most recent review (2021) focused only on physical activity interventions for cancer survivors in developed countries [ 10 ].…”