Economic Evaluation Studies

1

Economic Evaluations What they are and what
they are not
Moira NapperHealth Economics Research
UnitUniversity of Aberdeen
2
Issues Relating to the Health Economic Evaluation
Literature

• Methodological standards
• Quality of reporting
• Value-added information sources
• Formulation of search strategies

3
Purpose of Economic Evaluation Studies

• To ensure that the benefits from health care
  programmes implemented are greater than the the
  opportunity cost of such programmes
• by addressing questions of
• allocative efficiency or
• technical efficiency

4
Economic Evaluation Studies

• A FULL economic evaluation compares BOTH the
• costs AND consequences of
• two or more interventions
• Requires
• identification
• measurement
• valuation
• of both costs and benefits

5
Economic Evaluation Methodologies

• Cost-benefit analysis (CBA)
• Cost-utility analysis (CUA)
• Cost-effectiveness analysis (CEA)
• Cost-minimisation analysis (CMA)

6
Economic Evaluation Methodologies
7
Partial Economic Evaluation Studies

• cost comparison/cost analysis study
• cost of illness study
• cost outcome description
• cost description

8
Mislabelling of Economic Studies

• Zarnke, KB Levine, MAH OBrien, BJ.
  Cost-benefit analyses in the health-care
  literature dont judge a study by its label.
• Journal of Clinical Epidemiology 199750813-822
• Of a set of economic studies labelled CBA
• 68 did not use defined CBA methodology
• 53 were cost comparisons only

9
Quality of Health Economic Evaluation Studies

• Poor study design
• poor data sources
• failure to define clearly the economic evaluation
  method used
• use of an inappropriate method if economic
  evaluation to address the research question
• omission of sensitivity analysis to test
  robustness of modelling

10
Quality of Health Economic Evaluation Studies

• Inadequate reporting
• lack of transparency by authors
• journal editorial policy surrounding economic
  submissions
• Publication bias
• publication bias in the clinical literature
• motivation for conducting an economic evaluation

11
Guidelines for Economic Evaluation

• Conduct
• Pharmaceutical Reimbursement e.g. Australian
  fourth hurdle
• Methodology e.g. NICE, Washington Panel
• Reporting
• Drummond MF Jefferson TO. Guidelines for authors
  and peer reviewers of economic submissions to the
  BMJ. BMJ 1996313275-283
• Appraisal
• NHS Economic Evaluations Database (NHS EED)
  guidelines for structured abstracts
• BMJ Guidelines
• Weinstein MC. et al. Recommendations of the
  Panel on Cost-effectiveness in Health and
  Medicine. JAMA 19962761253-58
• Improving access to cost-effectiveness
  information for health care decision-making the
  NHS Economic Evaluation Database. NHSCRD Report
  no.6 (2nd ed). York. NHS Centre for Reviews

12
Searching Bibliographic Databases for Economic
Evaluations

• Indexing policy
• Availability of controlled vocabulary
• Specificity of indexing terms
• Indexing accuracy
• Clarity of description
• Accurate labelling
• consistency

13
Indexing - MeSH

• Economics
• Costs and Cost Analysis
• Cost Allocation
• Cost-Benefit analysis
• Cost Control (1)
• Cost of Illness
• Cost Sharing (2)
• Health Care Costs Direct Service
  Costs Drug Costs Employer Health
  Costs Hospital Costs
• Health expenditures (1)

14
Indexing - EMTREE

• Health Economics Economic Evaluation Cost
  Benefit Analysis Cost Control Cost
  Effectiveness Analysis Cost Minimization
  Analysis Cost of Illness Cost Utility
  Analysis Fee (5) Health Care Cost Drug
  Cost Health Care Financing Hospital Cost
  (3) Health Insurance (8) Pharmacoeconomics(5)
  

15
Value-added Bibliographic Sources of Health
Economic Evaluations

• Databases
• NHS Economic Evaluation Database (NHS EED)
• Health Economic Evaluations Database (HEED)
• EURONHEED
• CEA Registry (formerly Harvard CUA Database)
• Journals
• Evidence Based Health Care
• ACP Journal Club

16
NHS Economic Evaluation DatabaseNHS EED

• NHS Centre for Reviews DisseminationUniversity
  of York, UK
• Economic evaluations
• critical appraisal detailed structured abstract
• Other types of health economic analysis with
  bibliographic details
• MeSH searching
• 1995-

17
Health Economic Evaluations Database HEED

• Office of Health Economics, UK International
  Federation of Pharmaceutical Manufacturers
  Associations (OHE-IFPMA). www.ohe-heed.com/
• Structured format
• Bibliographic details
• Study definitions
• Analysis and results
• Keywords
• Expert review
• 1992 -

18
The CEA Registry Database of Cost-Utility
Analysis Studies

• Harvard Center for Risk Analysis
• www.hsph.harvard.edu/cearegistry/
• Reference list of studies that have used costs
  per QALY to measure health benefits 1976 - 2001
• Comprehensive league table of Cost-QALY Ratios
  1976-2001
• League table of cost-QALY ratios which adhere to
  the Washington Panel 1976-1997
• Catalogue of Preference Scores used for QALYs
• Audit checklist

19
European Network of Health Economics Evaluation
Databases (EURONHEED) Project

• Launched 2003 - 3 year development
• Country-specific databases set to be available in
  2005
• 7 regional databases covering 17 European
  countries
• 2 established viz. NHS EED (UK) and CODECS
  (France)
• 5 to be created viz. Germany, The Netherlands,
  Italy,Spain and Sweden

20
Health Economic Evaluation Studies Summary Points

• Strict definition criteria
• Quality variation
• Methodology
• Reporting
• Differences in bibliographic database indexing
• Specificity and
• Scope
• Use of value-added sources

21
National Information Center on Health Services
Research Health Care Technology (NLM/NIH)

• Etext of Health Technology Assessment (HTA)
  Information Resources (Chapter 11)
• www.nlm.nih.gov/nichsr/ehta/ehta.html
• Health Economics Information Resources a
  self-study course
• www.nlm.nih.gov/nichsr/edu/healthecon/