What Guidance are Economists Given on How to Present Economic Evaluations for Policymakers? A Systematic Review

Sullivan, Shannon; Wells, George A.; Coyle, Doug

doi:10.1016/j.jval.2015.06.007

Cited by 14 publications

(9 citation statements)

References 32 publications

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“…In combination with traditional health indicators such as mortality and morbidity, a comprehensive indicator (e.g. quality-adjusted life years or QALYs) can be calculated to inform clinical, funding, public policy and management decisions on health products and technologies [9–13].…”

Section: Introductionmentioning

confidence: 99%

Changes in health-related quality of life of Chinese populations measured by the EQ-5D-3 L: a comparison of the 2008 and 2013 National Health Services Surveys

Yao

Liu

Zhang

et al. 2019

Health Qual Life Outcomes

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BackgroundsThe EuroQol Group Five-Dimensional (EQ-5D) instruments have been validated in China for measuring health-related quality of life (HRQoL) and are increasingly being used in health economic studies. However, there is paucity in the literature documenting long-term changes in the EQ-5D results in the Chinese populations. This study aims to identify such changes and their determinants using the EQ-5D-3 L instrument.MethodsData were obtained from the National Health Services Surveys in China, which included the EQ-5D-3 L since 2008. We compared the differences between the 2008 and 2013 surveys in the percentage of reported problems, visual analogue scale (VAS) scores, and the EQ-5D-3 L utility index derived from the national value sets. Factors associated with population changes in these EQ-5D results were identified using logistic, linear and Tobit regression models, respectively.ResultsCompared with 2008, reported problems in self-care (3.3% vs 3.1%), usual activities (4.8% vs 4.6%) and anxiety/depression (6.4% vs 5.3%) decreased, whereas reported problems in mobility (5.1% vs 5.9%) and pain/discomfort (9.3% vs 12.6%) increased significantly (p < 0.05) in 2013. The regression models revealed a rise (β = 1.61, p < 0.001) in VAS scores, but a slight drop (β = − 0.01, p < 0.001) in utility index in 2013 compared with 2008 after controlling for variations in demographic, behavioral, socioeconomic and residential variables. But the effect sizes of the changes over time (estimated by “average change divided by baseline standard deviation”) did not reach the threshold of clinical importance after adjustment for variations in other factors. Higher socioeconomic status (in terms of education, income and residential location) was associated with better EQ-5D-3 L results.ConclusionThe changing trend (decrease) of the utility index is contradictory to that (increase) of the VAS scores, although neither is deemed clinically important. It is evident that socioeconomic and regional disparities in HRQoL exist in China.

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Section: Introductionmentioning

confidence: 99%

Changes in health-related quality of life of Chinese populations measured by the EQ-5D-3 L: a comparison of the 2008 and 2013 National Health Services Surveys

Yao

Liu

Zhang

et al. 2019

Health Qual Life Outcomes

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“…This was done to ensure that we present information that is useful to decision-makers and has been a driver in our decision to report the results as a PBMA. Reporting results over different time horizons and for a range of outcomes, not just QALYs, has also been recommended when reporting results for decision-makers [ 7 , 28 ]. Previous research has suggested that decision-makers rarely use QALYs, preferring hard clinical outcomes instead as they find them easier to understand [ 23 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Reporting results over different time horizons and for a range of outcomes, not just QALYs, has also been recommended when reporting results for decision-makers [ 7 , 28 ]. Previous research has suggested that decision-makers rarely use QALYs, preferring hard clinical outcomes instead as they find them easier to understand [ 23 , 28 ]. However, we have chosen to keep with QALYs given these can capture both mortality and morbidity – an important consideration in stroke care, which aims to improve functioning in addition to extending life.…”

Section: Discussionmentioning

confidence: 99%

The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England

Hunter

Fulop

Boaden

et al. 2018

Health Res Policy Sys

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BackgroundThe economic implications of major system change are an important component of the decision to implement health service reconfigurations. Little is known about how best to report the results of economic evaluations of major system change to inform decision-makers. Reconfiguration of acute stroke care in two metropolitan areas in England, namely London and Greater Manchester (GM), was used to analyse the economic implications of two different implementation strategies for major system change.MethodsA decision analytic model was used to calculate difference-in-differences in costs and outcomes before and after the implementation of two major system change strategies in stroke care in London and GM. Values in the model were based on patient level data from Hospital Episode Statistics, linked mortality data from the Office of National Statistics and data from two national stroke audits. Results were presented as net monetary benefit (NMB) and using Programme Budgeting and Marginal Analysis (PBMA) to assess the costs and benefits of a hypothetical typical region in England with approximately 4000 strokes a year.ResultsIn London, after 90 days, there were nine fewer deaths per 1000 patients compared to the rest of England (95% CI –24 to 6) at an additional cost of £770,027 per 1000 stroke patients admitted. There were two additional deaths (95% CI –19 to 23) in GM, with a total costs saving of £156,118 per 1000 patients compared to the rest of England. At a £30,000 willingness to pay the NMB was higher in London and GM than the rest of England over the same time period. The results of the PBMA suggest that a GM style reconfiguration could result in a total greater health benefit to a region. Implementation costs were £136 per patient in London and £75 in GM.ConclusionsThe implementation of major system change in acute stroke care may result in a net health benefit to a region, even one functioning within a fixed budget. The choice of what model of stroke reconfiguration to implement may depend on the relative importance of clinical versus cost outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12961-018-0301-5) contains supplementary material, which is available to authorized users.

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“…Reporting guidance focuses on providing transparent costeffectiveness information. This includes reporting study methods such as perspective, population, time horizon, effectiveness source, benefit measurement, study type, model type, SAs (both a list of parameters and range of ICERs), and base-case deterministic and probabilistic results [18]. Table 3 describes the methods used for reporting study results in the rapid review.…”

Section: Current Guidelinesmentioning

confidence: 99%

Challenges of Systematic Reviews of Economic Evaluations: A Review of Recent Reviews and an Obesity Case Study

2020

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Decision makers increasingly require cost-effectiveness evidence to inform resource allocation and the need for systematic reviews of economic evaluations (SREEs) has grown accordingly. The objective of this article is to describe current practice and identify unique challenges in conducting and reporting SREEs. Current guideline documents for SREEs were consulted and summarised. A rapid review of English-language SREEs, using MEDLINE and EMBASE, published in 2017/2018, containing at least 20 studies was undertaken to describe current practice. Information on data extraction methods, quality assessment (QA) tools and reporting methods were narratively summarised. Lessons learned from a recently conducted SREE of weight loss interventions for severely obese adults were discussed. Sixty-three publications were included in the rapid review. Substantial heterogeneity in review methods, reporting standards and QA approaches was evident. Our recently conducted SREE on weight loss interventions identified scope to improve process efficiency, opportunity for more transparent and succinct reporting, and potential to improve consistency of QA. Practical solutions may include (1) using pre-piloted data extraction forms linked explicitly to results tables; (2) consistently reporting on key assumptions and sensitivity analyses that drive results; and (3) using checklists that include topic-specific items where relevant and allow reviewers to distinguish between reporting, justification and QA. The lack of a mutually agreed, standardised set of best practice guidelines has led to substantial heterogeneity in the conduct and reporting of SREEs. Future work is required to standardise the approach to conducting SREEs so that they can generate efficient, timely and relevant evidence to support decision-making. We suggest only data extracting information that will be reported, focusing discussion around the key drivers of cost-effectiveness, and improving consistency in QA by distinguishing between what is reported, justified by authors and deemed appropriate by the reviewer.

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What Guidance are Economists Given on How to Present Economic Evaluations for Policymakers? A Systematic Review

Cited by 14 publications

References 32 publications

Changes in health-related quality of life of Chinese populations measured by the EQ-5D-3 L: a comparison of the 2008 and 2013 National Health Services Surveys

Changes in health-related quality of life of Chinese populations measured by the EQ-5D-3 L: a comparison of the 2008 and 2013 National Health Services Surveys

The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England

Challenges of Systematic Reviews of Economic Evaluations: A Review of Recent Reviews and an Obesity Case Study

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