scholarly journals PNS274 CRITICALLY APPRAISING SYSTEMATIC REVIEWS OF ECONOMIC EVALUATIONS: WHAT, WHY AND HOW? AN EXPLORATORY STUDY USING AN IRISH NATIONAL CLINICAL GUIDELINE

2019 ◽  
Vol 22 ◽  
pp. S809
Author(s):  
P. Carty ◽  
M. O'Neill ◽  
P. Harrington ◽  
T. Plunkett ◽  
M. Ryan ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Exploratory Study ◽  
Clinical Guideline ◽  
Economic Evaluations

Cochrane Reviews and Systematic Reviews of Economic Evaluations

1999 ◽  
Vol 16 (Supplement 1) ◽  
pp. 85-89 ◽  
Author(s):  
Tom Jefferson ◽  
Vittorio Demicheli ◽  
Daniela Rivetti ◽  
Jon Deeks
Keyword(s):  
Systematic Reviews ◽  
Economic Evaluations ◽  
Cochrane Reviews

scholarly journals Lenvatinib and sorafenib for differentiated thyroid cancer after radioactive iodine: a systematic review and economic evaluation

2020 ◽  
Vol 24 (2) ◽  
pp. 1-180 ◽  
Author(s):  
Nigel Fleeman ◽  
Rachel Houten ◽  
Adrian Bagust ◽  
Marty Richardson ◽  
Sophie Beale ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cost Effectiveness ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Clinical Effectiveness ◽  
Economic Evaluations ◽  
Base Case ◽  
The Cost

Background Thyroid cancer is a rare cancer, accounting for only 1% of all malignancies in England and Wales. Differentiated thyroid cancer (DTC) accounts for ≈94% of all thyroid cancers. Patients with DTC often require treatment with radioactive iodine. Treatment for DTC that is refractory to radioactive iodine [radioactive iodine-refractory DTC (RR-DTC)] is often limited to best supportive care (BSC). Objectives We aimed to assess the clinical effectiveness and cost-effectiveness of lenvatinib (Lenvima®; Eisai Ltd, Hertfordshire, UK) and sorafenib (Nexar®; Bayer HealthCare, Leverkusen, Germany) for the treatment of patients with RR-DTC. Data sources EMBASE, MEDLINE, PubMed, The Cochrane Library and EconLit were searched (date range 1999 to 10 January 2017; searched on 10 January 2017). The bibliographies of retrieved citations were also examined. Review methods We searched for randomised controlled trials (RCTs), systematic reviews, prospective observational studies and economic evaluations of lenvatinib or sorafenib. In the absence of relevant economic evaluations, we constructed a de novo economic model to compare the cost-effectiveness of lenvatinib and sorafenib with that of BSC. Results Two RCTs were identified: SELECT (Study of [E7080] LEnvatinib in 131I-refractory differentiated Cancer of the Thyroid) and DECISION (StuDy of sorafEnib in loCally advanced or metastatIc patientS with radioactive Iodine-refractory thyrOid caNcer). Lenvatinib and sorafenib were both reported to improve median progression-free survival (PFS) compared with placebo: 18.3 months (lenvatinib) vs. 3.6 months (placebo) and 10.8 months (sorafenib) vs. 5.8 months (placebo). Patient crossover was high (≥ 75%) in both trials, confounding estimates of overall survival (OS). Using OS data adjusted for crossover, trial authors reported a statistically significant improvement in OS for patients treated with lenvatinib compared with those given placebo (SELECT) but not for patients treated with sorafenib compared with those given placebo (DECISION). Both lenvatinib and sorafenib increased the incidence of adverse events (AEs), and dose reductions were required (for > 60% of patients). The results from nine prospective observational studies and 13 systematic reviews of lenvatinib or sorafenib were broadly comparable to those from the RCTs. Health-related quality-of-life (HRQoL) data were collected only in DECISION. We considered the feasibility of comparing lenvatinib with sorafenib via an indirect comparison but concluded that this would not be appropriate because of differences in trial and participant characteristics, risk profiles of the participants in the placebo arms and because the proportional hazard assumption was violated for five of the six survival outcomes available from the trials. In the base-case economic analysis, using list prices only, the cost-effectiveness comparison of lenvatinib versus BSC yields an incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained of £65,872, and the comparison of sorafenib versus BSC yields an ICER of £85,644 per QALY gained. The deterministic sensitivity analyses show that none of the variations lowered the base-case ICERs to < £50,000 per QALY gained. Limitations We consider that it is not possible to compare the clinical effectiveness or cost-effectiveness of lenvatinib and sorafenib. Conclusions Compared with placebo/BSC, treatment with lenvatinib or sorafenib results in an improvement in PFS, objective tumour response rate and possibly OS, but dose modifications were required to treat AEs. Both treatments exhibit estimated ICERs of > £50,000 per QALY gained. Further research should include examination of the effects of lenvatinib, sorafenib and BSC (including HRQoL) for both symptomatic and asymptomatic patients, and the positioning of treatments in the treatment pathway. Study registration This study is registered as PROSPERO CRD42017055516. Funding The National Institute for Health Research Health Technology Assessment programme.

scholarly journals Evidence of Workplace Interventions—A Systematic Review of Systematic Reviews

2019 ◽  
Vol 16 (19) ◽  
pp. 3553 ◽  
Author(s):  
Claudia Pieper ◽  
Sarah Schröer ◽  
Anna-Lisa Eilerts
Keyword(s):  
Health Promotion ◽  
Systematic Reviews ◽  
Search Strategy ◽  
Workplace Health Promotion ◽  
Well Being ◽  
Current Evidence ◽  
Economic Evaluations ◽  
High Quality ◽  
Older Employees ◽  
Health Promotion Interventions

Work environment factors are highly correlated with employees’ health and well-being. Our aim was to sum up current evidence of health promotion interventions in the workplace, focusing on interventions for the prevention of musculoskeletal disorders, psychological and behavioral disorders as well as interventions for older employees and economic evaluations. We conducted a comprehensive literature search including systematic reviews published from April 2012 to October 2017 in electronic databases and search engines, websites of relevant organizations and institutions. It consisted of simple and specific terms and word combinations related to workplace health promotion based on the search strategy of a previous review. After full-text screening, 74 references met the eligibility criteria. Using the same search strategy, there was a higher proportion of relevant high-quality studies as compared with the earlier review. The heterogeneity of health promotion interventions regarding intervention components, settings and study populations still limits the comparability of studies. Future studies should also address the societal and insurer perspective, including costs to the worker such as lost income and lost time at work of family members due to caregiving activities. To this end, more high-quality evidence is needed.

scholarly journals Challenges in synthesising cost-effectiveness estimates

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Gemma E. Shields ◽  
Jamie Elvidge
Keyword(s):  
Cost Effectiveness ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cost Effective ◽  
Evidence Base ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Study Designs

AbstractEconomic evaluations help decision-makers faced with tough decisions on how to allocate resources. Systematic reviews of economic evaluations are useful as they allow readers to assess whether interventions have been demonstrated to be cost effective, the uncertainty in the evidence base, and key limitations or gaps in the evidence base. The synthesis of systematic reviews of economic evaluations commonly takes a narrative approach whereas a meta-analysis is common step for reviews of clinical evidence (e.g. effectiveness or adverse event outcomes). As they are common objectives in other reviews, readers may query why a synthesis has not been attempted for economic outcomes. However, a meta-analysis of incremental cost-effectiveness ratios, costs, or health benefits (including quality-adjusted life years) is fraught with issues largely due to heterogeneity across study designs and methods and further practical challenges. Therefore, meta-analysis is rarely feasible or robust. This commentary outlines these issues, supported by examples from the literature, to support researchers and reviewers considering systematic review of economic evidence.

scholarly journals Can database-level MEDLINE exclusion filters in Embase and CINAHL be used to remove duplicate records without loss of relevant studies in systematic reviews? An exploratory study

2020 ◽  
Vol 41 (1) ◽  
pp. 3-15
Author(s):  
Zahra Premji ◽  
Heather Ganshorn
Keyword(s):  
Systematic Reviews ◽  
Exploratory Study ◽  
Search Strategies ◽  
Medline Search ◽  
Small Risk ◽  
Cochrane Reviews ◽  
Sample Set

Objective: To investigate whether using database filters to remove MEDLINE results within Embase (OVID) and CINAHL (EBSCO) would result in fewer records, without leading to any loss of studies included in the final review. Methods: We reviewed the included studies from a sample set of 20 Cochrane Reviews, and replicated the search strategies from those reviews in MEDLINE, Embase (both on the OVID platform) and CINAHL (EBSCO). Results were exported to EndNote; then relevant MEDLINE filters were applied within each database, and results were exported again. Filtered results were analysed to determine whether the filtered Embase and CINAHL results excluded relevant studies that were not identified in the original MEDLINE search.  Results: Using the “Records from: Embase” filter resulted in no loss of included studies; however, the “Exclude MEDLINE journals” filter in Embase resulted in a failure to retrieve a large number of relevant studies. CINAHL’s filter for MEDLINE records resulted in a very small number of studies being lost. Conclusions: The “Records from: Embase” filter may be safely used for deduplication, though as it removes conferences, searchers may also want to review Conference abstracts separately using the Conferences filter. CINAHL’s MEDLINE filter comes with a small risk of filtering out relevant studies, but may be appropriate to use. Though we did not set out to address this question, our results also demonstrate that it is not advisable to rely on an unfiltered search of Embase alone in order to identify all relevant studies.

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