Key problems in the economic reviews. There remained several discrepant opinions on the review techniques, such as applicability of foreign studies, overall quality of economic studies, and addressing study heterogeneity.

Tags: Poster
Sun X, Orlewska, E, Yang H, Li Y

Background: Since 2002, the methods of Cochrane systematic reviews (CSRs) have been used for selecting essential drugs in China. These methods, though efficient in comparing effectiveness of competing drugs, cannot address comparative cost-effectiveness, which causes difficulties of evidence-based decision-making.

Objectives: This study aims to investigate methods for valuing comparative cost-effectiveness, which is appropriate for selection of essential drugs in the Chinese setting.

Methods: A comprehensive review of existing guidelines/recommendations for economic evaluation of health technologies was conducted. These guidelines/recommendations were obtained from Medline and HTA agencies worldwide, and analyzed by comparison for their methodological strength and limitation. A research panel, including pharmacoeconomists and decision-makers, discussed analytical results in relation to the Chinese setting, and developed a methodological framework.

Results: Twelve guidelines/recommendations were obtained and analyzed. Nine of them related to preparation of new economic evaluation however varied in their methodological emphases. Other three, although focusing on systematic approaches of evaluation, adapted different methods. By comparing these guidelines/recommendations, re-constructed methods were established at the Chinese standings.

1. Evaluation process. Two major steps were formulated: reviewing existing evidence and conducting new economic evaluation (fig 1 on the following page). Systematic review of economic evidence was emphasized, and should be conducted whenever possible.

2. Aspects of economic review. Four steps were set up for reviewing economic evidence, each containing essential regulations (table 1 on the following page).

3. Evidence base. Three evidence scenarios and "flow-on" procedures were proposed (Fig 1 on the following page).

a. sufficient and adequate existing evidence that could reach a sound conclusion;

b. sufficient but inadequate evidence that needed more investigations at certain points;

c. insufficient and inadequate evidence that needed new economic evaluations.

4. New economic evaluation. It should be designed in accordance with the established economic framework (table 1 on the following page). The methods should be justified and results be presented in detail.

Conclusions: The method was developed on the basis of existing guidelines/recommendations, and appeared efficient for addressing comparative cost-effectiveness.