Article type
Year
Abstract
Introduction/Objective: Systematic review of the literature has been advocated as one approach towards evidence based medicine (EBM) but their value to decision makers is limited without information on resource use. Yet such systematic reviews lend to be restricted to the consideration of benefits which in turn are limited to clinical outcomes alone. Case studies incorporating health economics into this process are rare. We use a systematic review in the area of end stage renal disease (ESRD) study explores the role of economics in helping to define optimal care and investigates how economics can be incorporated into the process of systematic reviews.
Methods: The aim was to compare the effectiveness and efficiency of bicarbonate and acetate haemodialyate in patients with ESRD. Haemodialysis takes over the function of the kidneys when a patient develops ESRD. Correction of acidosis is a major part of this and haemodialysalts including acetate and bicarbonate can be used. There were three stages to the case study: (i) the systematic review of the literature and the meta-analysis of this data on effectiveness; (ii) the synthesis of data on resource use and cost; and (iii) the combination of these data to estimate the relative efficiency of the two modes of treatment.
Results: The case study has shown that economics can be incorporated into the process of systematic reviews. In this case study, bicarbonate haemodialyate has been shown to be both more effective and less costly than acetate haemodialyate and hence more efficient. However, the scope of the review was limited by the types of outcomes reported in the primary trials.
Discussion: Economics can be incorporated into systematic reviews even where no formal economic appraisals of health care interventions have previously been conducted. The consideration of benefits in systematic reviews, however, are frequently based upon clinical outcomes and thus may miss aspects of benefits that are important to patients such as information, reassurance and acceptability. In the absence of such information conclusions about the overall efficiency of the treatment options must be cautious. The questionable generalisability of data from the settings of the primary research also limit the usefulness of the results. Sensitivity analysis is one way to address these problems.
Methods: The aim was to compare the effectiveness and efficiency of bicarbonate and acetate haemodialyate in patients with ESRD. Haemodialysis takes over the function of the kidneys when a patient develops ESRD. Correction of acidosis is a major part of this and haemodialysalts including acetate and bicarbonate can be used. There were three stages to the case study: (i) the systematic review of the literature and the meta-analysis of this data on effectiveness; (ii) the synthesis of data on resource use and cost; and (iii) the combination of these data to estimate the relative efficiency of the two modes of treatment.
Results: The case study has shown that economics can be incorporated into the process of systematic reviews. In this case study, bicarbonate haemodialyate has been shown to be both more effective and less costly than acetate haemodialyate and hence more efficient. However, the scope of the review was limited by the types of outcomes reported in the primary trials.
Discussion: Economics can be incorporated into systematic reviews even where no formal economic appraisals of health care interventions have previously been conducted. The consideration of benefits in systematic reviews, however, are frequently based upon clinical outcomes and thus may miss aspects of benefits that are important to patients such as information, reassurance and acceptability. In the absence of such information conclusions about the overall efficiency of the treatment options must be cautious. The questionable generalisability of data from the settings of the primary research also limit the usefulness of the results. Sensitivity analysis is one way to address these problems.