Article type
Year
Abstract
Introduction: There is increasing interest in the conduct of economic evaluations alongside systematic reviews. This should ensure, that the best available evidence is used to assess both effectiveness and efficiency of interventions. Though there are a number of examples of economic appraisal combined with systematic review it is unclear how such appraisals should, best be reported within the current Cochrane framework.
Objectives: The purpose of this presentation is to explore some of the options.
Methods:
Results:
Discussion: There are at least four possible options:
a. Do not include economics in the reviews at all,
b. Provide a list of references of all known relevant economic appraisals,
c. Systematically identify and review relevant economic appraisals,
d. Change the format of the Cochrane review so that more formal economic appraisal can be incorporated.
The first option is the standard approach at the moment. It provides no indication that any economics has been performed or even that there are important economic issues that should be considered. The second option overcomes some of the problems of the first option by pointing to where relevant information can be found. The third option attempts to apply the principles of systematic review to published data from individual economic evaluations, albeit of variable design and quality. The fourth option is the most ambitious and would involve changing the way reviews are presented within the Cochrane Library. It would involve applying best estimates of resource use, possibly obtained by new data collection, to estimates of effectiveness. There are, however, issues about the transferability of economic data - the results calculated for one country or setting may not be applicable to another. One way to overcome this problem, at least partially, is ensure the amount of resources that are used as the basis of cost estimates for the interventions evaluated are explicitly stated allowing varying cost assumptions to be applied in a sensitivity analysis. An example of this last approach, taken from a systematic review of methods of renal dialysis management, will be used to illustrate the potential of the approach and how it could fit within the Cochrane framework.
Objectives: The purpose of this presentation is to explore some of the options.
Methods:
Results:
Discussion: There are at least four possible options:
a. Do not include economics in the reviews at all,
b. Provide a list of references of all known relevant economic appraisals,
c. Systematically identify and review relevant economic appraisals,
d. Change the format of the Cochrane review so that more formal economic appraisal can be incorporated.
The first option is the standard approach at the moment. It provides no indication that any economics has been performed or even that there are important economic issues that should be considered. The second option overcomes some of the problems of the first option by pointing to where relevant information can be found. The third option attempts to apply the principles of systematic review to published data from individual economic evaluations, albeit of variable design and quality. The fourth option is the most ambitious and would involve changing the way reviews are presented within the Cochrane Library. It would involve applying best estimates of resource use, possibly obtained by new data collection, to estimates of effectiveness. There are, however, issues about the transferability of economic data - the results calculated for one country or setting may not be applicable to another. One way to overcome this problem, at least partially, is ensure the amount of resources that are used as the basis of cost estimates for the interventions evaluated are explicitly stated allowing varying cost assumptions to be applied in a sensitivity analysis. An example of this last approach, taken from a systematic review of methods of renal dialysis management, will be used to illustrate the potential of the approach and how it could fit within the Cochrane framework.