Use of evidence in economic decision models: practical issues and methodological challenges

Cooper, Nicola J.; Sutton, Alex J.; Ades, A E; Paisley, Suzy; Jones, David R.

doi:10.1002/hec.1297

Cited by 47 publications

(61 citation statements)

References 24 publications

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“…60 However, the identification of all relevant evidence is very demanding and most search strategies practised lack uniformity and transparency. 124 There are no clear guidelines on this process and a recent review of modelling guidelines reported inconsistent advice. 59 This methodological issue has been recognised and more guidance on searches for model parameters is anticipated.…”

Section: Cost-effectiveness Methodsmentioning

confidence: 99%

“…Possible data sources have been categorised as research based, real world based and reference based. 118,124 Research-based sources of evidence include RCTs, meta-analyses of RCTs, observational studies and economic models. Examples of real-world data sources are administrative databases, hospital or other health-care statistics and disease registers.…”

Section: Evidence Used In Decision Modelsmentioning

confidence: 99%

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A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Graves

Wloch

Wilson

et al. 2016

Health Technol Assess

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BackgroundA deep infection of the surgical site is reported in 0.7% of all cases of total hip arthroplasty (THA). This often leads to revision surgery that is invasive, painful and costly. A range of strategies is employed in NHS hospitals to reduce risk, yet no economic analysis has been undertaken to compare the value for money of competing prevention strategies.ObjectivesTo compare the costs and health benefits of strategies that reduce the risk of deep infection following THA in NHS hospitals. To make recommendations to decision-makers about the cost-effectiveness of the alternatives.DesignThe study comprised a systematic review and cost-effectiveness decision analysis.Setting77,321 patients who had a primary hip arthroplasty in NHS hospitals in 2012.InterventionsNine different treatment strategies including antibiotic prophylaxis, antibiotic-impregnated cement and ventilation systems used in the operating theatre.Main outcome measuresChange in the number of deep infections, change in the total costs and change in the total health benefits in quality-adjusted life-years (QALYs).Data sourcesLiterature searches using MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials were undertaken to cover the period 1966–2012 to identify infection prevention strategies. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. Orthopaedic surgeons and infection prevention experts were also consulted.Review methodsEnglish-language papers only. The selection of evidence was by two independent reviewers. Studies were included if they were interventions that reported THA-related deep surgical site infection (SSI) as an outcome. Mixed-treatment comparisons were made to produce estimates of the relative effects of competing infection control strategies.ResultsTwelve studies, six randomised controlled trials and six observational studies, involving 123,788 total hip replacements (THRs) and nine infection control strategies, were identified. The quality of the evidence was judged against four categories developed by the National Institute for Health and Care ExcellenceMethods for Development of NICE Public Health Guidance(http://publications.nice.org.uk/methods-for-the-development-of-nice-public-health-guidance-third-edition-pmg4), accessed March 2012. All evidence was found to fit the two highest categories of 1 and 2. Nine competing infection control interventions [treatments (Ts) 1–9] were used in a cohort simulation model of 77,321 patients who had a primary THR in 2012. Predictions were made for cases of deep infection and total costs, and QALY outcomes. Compared with a baseline of T1 (no systemic antibiotics, plain cement and conventional ventilation) all other treatment strategies reduced risk. T6 was the most effective (systemic antibiotics, antibiotic-impregnated cement and conventional ventilation) and prevented a further 1481 cases of deep infection, and led to the largest annual cost savings and the greatest gains to QALYs. The additional uses of laminar airflow and body exhaust suits indicate higher costs and worse health outcomes.ConclusionsT6 is an optimal strategy for reducing the risk of SSI following THA. The other strategies that are commonly used among NHS hospitals lead to higher cost and worse QALY outcomes. Policy-makers, therefore, have an opportunity to save resources and improve health outcomes. The effects of laminar air flow and body exhaust suits might be further studied if policy-makers are to consider disinvesting in these technologies.LimitationsA wide range of evidence sources was synthesised and there is large uncertainty in the conclusions.FundingThe National Institute for Health Research Health Technology Assessment programme and the Queensland Health Quality Improvement and Enhancement Programme (grant number 2008001769).

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Section: Cost-effectiveness Methodsmentioning

confidence: 99%

Section: Evidence Used In Decision Modelsmentioning

confidence: 99%

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Graves

Wloch

Wilson

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

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“…Within health economics, however, while there have been significant advances in evidence synthesis methods based on decision analytic modelling (Ades et al, 2006;Cooper et al, 2007;Weinstein, 2006), and a key book on the role of systematic reviews and health economics was published in 2002 (Donaldson et al, 2002a), this debate has been comparatively limited. Nevertheless, systematic reviews of economic studies have become a key feature of many policy making and technology assessment processes, and also a common form of published study in certain health economics journals.…”

Section: Introductionmentioning

confidence: 98%

Systematic reviews of economic evaluations: utility or futility?

Anderson

2010

Health Economics

138

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Systematic reviews of studies of effectiveness are the centrepiece of evidence-based medicine and policy making. Increasingly, systematic reviews of economic evaluations are also an expected input into much evidence-based policy making, with some health economists even calling for 'an economics approach to systematic review'. This paper questions the value of conducting systematic reviews of economic evaluations to inform decision making in health care. It argues that the value of systematic reviews of economic evaluations is usually undermined by three things. Firstly, compared with effectiveness studies, there is a much wider range of factors that limit the generalisability of cost-effectiveness results, over time and between health systems and service settings, including the context-dependency of resource use and opportunity costs, and different decision contexts and budget constraints. Secondly, because economic evaluations are more explicitly intended to be decision-informing, the requirements for generalisability take primacy, and considerations of internal validity become more secondary. Thirdly, since one of the two main forms of economic evaluation - decision analytic modelling - is itself a well-developed method of evidence synthesis, in most cases the need for a comprehensive systematic review of previous economic evaluations of a particular health technology or policy choice is unwarranted. I conclude that apparent 'meta-analytic expectations' for clear and widely applicable cost-effectiveness conclusions from systematic reviews of economic evaluations are optimistic and generally futile. For more useful insights and knowledge from previous economic studies in evidence-based policy making, a more limited range of reasons for conducting systematic reviews of health economic studies is proposed.

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“…Moreover, if a drug is effective, a cost-effectiveness analysis at the population level could be used to synthesise the data from multiple cohorts and trials into a form that is more explicit for decision makers (Cooper et al 2007). In such a model, factors like cost, demographics, the availability of appropriate tests, the incidence of toxoplasmosis infection in pregnant women and of clinical symptoms in children must be taken into consideration to evaluate future options and recommendations (Ades 2005, personal communication at the EuroTOXO consensus conference).…”

Section: How To Inform Future Trials and Recommendations?mentioning

confidence: 99%

Options for clinical trials of pre and post-natal treatments for congenital toxoplasmosis

Chêne

Thiébaut

2009

Mem. Inst. Oswaldo Cruz

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Use of evidence in economic decision models: practical issues and methodological challenges

Cited by 47 publications

References 24 publications

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Systematic reviews of economic evaluations: utility or futility?

Options for clinical trials of pre and post-natal treatments for congenital toxoplasmosis

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