Check Your Checklist: The Danger of Over- and Underestimating the Quality of Economic Evaluations

IntroductionThe combination of biomarkers and drugs is the subject of growing interest both from regulators, physicians and companies. This study protocol of a systematic review is aimed to describe available literature evidences about the cost-effectiveness, cost-utility or net-monetary benefit of the use of biomarkers in solid tumour as tools for customising immunotherapy to identify what further research needs.Methods and analysisA systematic review of the literature will be carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. PubMed and Embase will be queried from June 2010 to June 2021. The PICOS model will be applied: target population (P) will be patients with solid tumours treated with immune checkpoint inhibitors (ICIs); the interventions (I) will be test of the immune checkpoint predictive biomarkers; the comparator (C) will be any other targeted or non-targeted therapy; outcomes (O) evaluated will be health economic and clinical implications assessed in terms of incremental cost-effectiveness ratio, net health benefit, net monetary benefit, life years gained, quality of life, etc; study (S) considered will be economic evaluations reporting cost-effectiveness analysis, cost-utility analysis, net-monetary benefit. The quality of the evidence will be graded according to Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationThis systematic review will assess the cost-effectiveness implications of using biomarkers in the immunotherapy with ICIs, which may help to understand whether this approach is widespread in real clinical practice. This research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal.PROSPERO registration numberCRD42020201549.

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Comparison of (Partial) economic evaluations of transforaminal lumbar interbody fusion (TLIF) versus Posterior lumbar interbody fusion (PLIF) in adults with lumbar spondylolisthesis: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0245963 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0245963

Author(s):

Inge J. M. H. Caelers ◽

Suzanne L. de Kunder ◽

Kim Rijkers ◽

Wouter L. W. van Hemert ◽

Rob A. de Bie ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Cost Effectiveness ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Economic Evaluations ◽

Lumbar Interbody Fusion ◽

Lumbar Spondylolisthesis

Introduction The demand for spinal fusion surgery has increased over the last decades. Health care providers should take costs and cost-effectiveness of these surgeries into account. Open transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are two widely used techniques for spinal fusion. Earlier research revealed that TLIF is associated with less blood loss, shorter surgical time and sometimes shorter length of hospital stay, while effectiveness of both techniques on back and/or leg pain are equal. Therefore, TLIF could result in lower costs and be more cost-effective than PLIF. This is the first systematic review comparing direct and indirect (partial) economic evaluations of TLIF with PLIF in adults with lumbar spondylolisthesis. Furthermore, methodological quality of included studies was assessed. Methods Searches were conducted in eight databases for reporting on eligibility criteria; TLIF or PLIF, lumbar spondylolisthesis or lumbar instability, and cost. Costs were converted to United States Dollars with reference year 2020. Study quality was assessed using the bias assessment tool of the Cochrane Handbook for Systematic Reviews of Interventions, the Level of Evidence guidelines of the Oxford Centre for Evidence-based Medicine and the Consensus Health Economic Criteria (CHEC) list. Results Of a total of 693 studies, 16 studies were included. Comparison of TLIF and PLIF could only be made indirectly, since no study compared TLIF and PLIF directly. There was a large heterogeneity in health care and societal perspective costs due to different in-, and exclusion criteria, baseline characteristics and the use of costs or charges in calculations. Health care perspective costs, calculated with hospital costs, ranged from $15,867-$43,217 in TLIF-studies and $32,662 in one PLIF-study. Calculated with hospital charges, it ranged from $8,964-$51,469 in TLIF-studies and $21,838-$93,609 in two PLIF-studies. Societal perspective costs and cost-effectiveness, only mentioned in TLIF-studies, ranged from $5,702/QALY-$48,538/QALY and $50,092/QALY-$90,977/QALY, respectively. Overall quality of studies was low. Conclusions This systematic review shows that TLIF and PLIF are expensive techniques. Moreover, firm conclusions about the preferable technique, based on (partial) economic evaluations, cannot be drawn due to limited studies and heterogeneity. Randomized prospective trials and full economical evaluations with direct TLIF and PLIF comparison are needed to obtain high levels of evidence. Furthermore, development of guidelines to perform adequate economic evaluations, specified for the field of interest, will be useful to minimize heterogeneity and maximize transferability of results. Trial registration Prospero-database registration number: CRD42020196869.

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The economic benefits of rehabilitation for neurological conditions

Oxford Textbook of Neurorehabilitation ◽

10.1093/med/9780198824954.003.0003 ◽

2020 ◽

pp. 23-30

Author(s):

Rory J. O’Connor

Keyword(s):

Psychological Functioning ◽

Cost Effective ◽

Economic Benefits ◽

Economic Evaluations ◽

Healthcare Intervention ◽

Effective Interventions ◽

Neurological Conditions ◽

Economic Analyses

Rehabilitation programmes are highly cost-effective interventions that restore people’s independence, dignity, and quality of life. In the past there was an impression that they appeared expensive, which resulted in a lack of enthusiasm to develop them by funding bodies and commissioners. However, the evidence demonstrating the long-term cost-effectiveness of rehabilitation is robust. Many people with long-term neurological conditions will live for many years after the onset of the condition and investment in their physical and psychological functioning early on will, over that person’s lifetime, will result in substantial savings. Nevertheless, calculating economic evaluations can be complicated and the correct measure must be chosen to identify the change produced by the rehabilitation intervention. These data must then be handled appropriately, and any ancillary costs included. The economic impact of the rehabilitation programme is wider than a purely healthcare intervention and will include potential earnings and reduced costs to social care. The economic analyses will also include housing, education, and vocational outcomes, and the effect of the long-term condition on family members who may have a caring role.

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A Systematic Review of the Economic Burden of Type 2 Diabetes in Malaysia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165723 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5723

Author(s):

Kurubaran Ganasegeran ◽

Chee Peng Hor ◽

Mohd Fadzly Amar Jamil ◽

Hong Chuan Loh ◽

Juliana Mohd Noor ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Economic Burden ◽

Data Extraction ◽

Policy Decision ◽

Economic Evaluations ◽

Total Annual Cost ◽

Adult Type

Diabetes causes significant disabilities, reduced quality of life and mortality that imposes huge economic burden on societies and governments worldwide. Malaysia suffers a high diabetes burden in Asia, but the magnitude of healthcare expenditures documented to aid national health policy decision-making is limited. This systematic review aimed to document the economic burden of diabetes in Malaysia, and identify the factors associated with cost burden and the methods used to evaluate costs. Studies conducted between 2000 and 2019 were retrieved using three international databases (PubMed, Scopus, EMBASE) and one local database (MyCite), as well as manual searches. Peer reviewed research articles in English and Malay on economic evaluations of adult type 2 diabetes conducted in Malaysia were included. The review was registered with PROSPERO (CRD42020151857), reported according to PRISMA and used a quality checklist adapted for cost of illness studies. Data were extracted using a data extraction sheet that included study characteristics, total costs, different costing methods and a scoring system to assess the quality of studies reviewed. The review identified twelve eligible studies that conducted cost evaluations of type 2 diabetes in Malaysia. Variation exists in the costs and methods used in these studies. For direct costs, four studies evaluated costs related to complications and drugs, and two studies were related to outpatient and inpatient costs each. Indirect and intangible costs were estimated in one study. Four studies estimated capital and recurrent costs. The estimated total annual cost of diabetes in Malaysia was approximately USD 600 million. Age, type of hospitals or health provider, length of inpatient stay and frequency of outpatient visits were significantly associated with costs. The most frequent epidemiological approach employed was prevalence-based (n = 10), while cost analysis was the most common costing approach used. The current review offers the first documented evidence on cost estimates of diabetes in Malaysia.

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Critical review of economic evaluations in multiple myeloma: An overview of the economic evidence and quality of the methodology

European Journal of Cancer ◽

10.1016/j.ejca.2011.04.005 ◽

2011 ◽

Vol 47 (10) ◽

pp. 1458-1467 ◽

Cited By ~ 10

Author(s):

Jennifer G. Gaultney ◽

W.K. Redekop ◽

Pieter Sonneveld ◽

Carin A. Uyl-de Groot

Keyword(s):

Multiple Myeloma ◽

Critical Review ◽

Economic Evaluations ◽

Economic Evidence

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Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462305050324 ◽

2005 ◽

Vol 21 (2) ◽

pp. 240-245 ◽

Cited By ~ 379

Author(s):

Silvia Evers ◽

Mariëlle Goossens ◽

Henrica de Vet ◽

Maurits van Tulder ◽

André Ament

Keyword(s):

Health Economic ◽

Systematic Reviews ◽

Methodological Quality ◽

Economic Evaluations ◽

Delphi Panel ◽

Policy Makers ◽

Core Set ◽

International Experts ◽

Economic Criteria

Objectives:The aim of the Consensus on Health Economic Criteria (CHEC) project is to develop a criteria list for assessment of the methodological quality of economic evaluations in systematic reviews. The criteria list resulting from this CHEC project should be regarded as a minimum standard.Methods:The criteria list has been developed using a Delphi method. Three Delphi rounds were needed to reach consensus. Twenty-three international experts participated in the Delphi panel.Results:The Delphi panel achieved consensus over a generic core set of items for the quality assessment of economic evaluations. Each item of the CHEC-list was formulated as a question that can be answered by yes or no. To standardize the interpretation of the list and facilitate its use, the project team also provided an operationalization of the criteria list items.Conclusions:There was consensus among a group of international experts regarding a core set of items that can be used to assess the quality of economic evaluations in systematic reviews. Using this checklist will make future systematic reviews of economic evaluations more transparent, informative, and comparable. Consequently, researchers and policy-makers might use these systematic reviews more easily. The CHEC-list can be downloaded freely fromhttp://www.beoz.unimaas.nl/chec/.

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The Methodological Quality and Challenges in Conducting Economic Evaluations of Newborn Screening: A Scoping Review

International Journal of Neonatal Screening ◽

10.3390/ijns6040094 ◽

2020 ◽

Vol 6 (4) ◽

pp. 94

Author(s):

Pasquale Cacciatore ◽

Laurenske A. Visser ◽

Nasuh Buyukkaramikli ◽

Catharina P. B. van der Ploeg ◽

M. Elske van den Akker-van Marle

Keyword(s):

Resource Allocation ◽

Cost Effectiveness ◽

Newborn Screening ◽

Scoping Review ◽

Methodological Quality ◽

Economic Evaluations ◽

Screening Programs ◽

Methodological Challenges ◽

Life Years

Cost-effectiveness (CEA) and cost–utility analyses (CUA) have become popular types of economic evaluations (EE) used for evidence-based decision-making in healthcare resource allocation. Newborn screening programs (NBS) can have significant clinical benefits for society, and cost-effectiveness analysis may help to select the optimal strategy among different screening programs, including the no-screening option, on different conditions. These economic analyses of NBS, however, are hindered by several methodological challenges. This study explored the methodological quality in recent NBS economic evaluations and analyzed the main challenges and strategies adopted by researchers to deal with them. A scoping review was conducted according to PRISMA methodology to identify CEAs and CUAs of NBS. The methodological quality of the retrieved studies was assessed quantitatively using a specific guideline for the quality assessment of NBS economic evaluations, by calculating a general score for each EE. Challenges in the studies were then explored using thematic analysis as a qualitative synthesis approach. Thirty-five studies met the inclusion criteria. The quantitative analysis showed that the methodological quality of NBS economic evaluations was heterogeneous. Lack of clear description of items related to results, discussion, and discounting were the most frequent flaws. Methodological challenges in performing EEs of neonatal screenings include the adoption of a long time horizon, the use of quality-adjusted life years as health outcome measure, and the assessment of costs beyond the screening interventions. The results of this review can support future economic evaluation research, aiding researchers to develop a methodological guidance to perform EEs aimed at producing solid results to inform decisions for resource allocation in neonatal screening.

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Standard methods for studying pharmaceutical economy

Urologia Journal ◽

10.1177/039156039706400427 ◽

1997 ◽

Vol 64 (4) ◽

pp. 474-477

Author(s):

G. De Grande ◽

A. Scandurra

Keyword(s):

Good Health ◽

Economic Research ◽

Economic Evaluations ◽

External Quality Control ◽

External Quality ◽

Anatomic Therapeutic Chemical ◽

Accepted Standard ◽

And Control ◽

Working Method

– It is necessary to check the quality of the expense for the production of “public good health” and find elements of evaluation and control whereby results may be compared, also considering the medicines used and the expenses incurred. Universally-accepted standard parameters allow analogous situations to be compared. In the case of epidemiological and pharmaceutical-economic research the accepted parameters are: medicine classification according to the A.T.C. (anatomic - therapeutic - chemical) method and assessment of the exposure to medicines of a group or population, according to the D.D.D. (defined dose per day) method. From February to March and September to October 1995, the men's section of the urology ward was evaluated in relation to “G04 AB” medicines, analysed in the 5th level according to the A.T.C. method. The working method is standardised and although not absolute, enables pharmaco-economic evaluations to be made between work groups with similar situations. Furthermore, despite not being complete in itself, it could become a system of external quality control.

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