scholarly journals Assessing Transferability in Systematic Reviews of Health Economic Evaluations – A Review of Methodological Guidance

2021 ◽  
Author(s):  
Alina Weise ◽  
Roland Brian Büchter ◽  
Dawid Pieper ◽  
Tim Mathes
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Health Technology Assessment ◽  
Systematic Reviews ◽  
Technology Assessment ◽  
Health Technology ◽  
High Variability ◽  
Assessment Criteria ◽  
Economic Evaluations ◽  
Resource Needs

Abstract Objective: For assessing cost-effectiveness, Health Technology Assessment (HTA) organisations may use primary economic evaluations (P-HEs) or Systematic Reviews of Health Economic evaluations (SR-HEs). The latter pose the question whether the results from existing P-HEs are transferable across decision contexts (e.g. jurisdictions). A particularly pertinent issue is the high variability of costs and resource needs across jurisdictions. Our objective was to review the methods documents of HTA organisations and compare their recommendations on considering transferability in SR-HE. Methods: We systematically hand searched the webpages of 158 HTA organisations for relevant methods documents from January to March 2019. Two independent reviewers performed searches and selected documents according to pre-defined criteria. One reviewer extracted data in standardised and piloted tables and a second reviewer checked them for accuracy. We synthesized data using tabulations and in a narrative way. Results: We identified 155 potentially relevant documents from 63 HTA organisations. Of these, 7 were included in the synthesis. The included organisations have different aims when preparing a SR-HE (e.g. to determine the need for conducting their own P-HE). The recommendations vary regarding the underlying terminology (e.g. transferability/generalisability), the assessment approaches (e.g. structure), the assessment criteria and the integration in the review process.Conclusion: Only few HTA organisations address the assessment of transferability in their methodological recommendations for SR-HEs. Transferability considerations are related to different purposes. The assessment concepts and criteria are heterogeneous. Developing standards to consider transferability in SR-HEs is desirable.

scholarly journals Imaginary Worlds: The European Network for Health Technology Assessment (EUnetHTA) Recommendations for Health Economic Evaluations

2016 ◽  
Vol 7 (3) ◽  
Author(s):  
Paul C Langley
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Relative Effectiveness ◽  
Health Technology ◽  
Economic Evaluations ◽  
Normal Science ◽  
European Network ◽  
Health Technologies

The European Network for Health Technology Assessment (EUnetHTA) guidelines for health economic evaluations represent a consolidated view of non-binding recommendations for assessments of the relative effectiveness of pharmaceuticals or other health technologies. EUnetHTA views itself as the scientific and technological backbone of the development of health technology assessment in the European Union and among its member states and other partners. Unfortunately, the standards for health technology assessment proposed by EUnetHTA do not meet the standards of normal science. They do not support credible claims for the clinical and comparative cost-effectiveness of pharmaceuticals. In rejecting the standards of normal science the guidelines put to one side the opportunity not only to re-assess and replicate clinical and cost-effectiveness claims but to provide meaningful feedback on claims assessment to health care decision makers. The purpose of this review is to make the case that, in failing to support standards for experimentation, EUnetHTA is advocating its partners support the creation of modeled or simulated imaginary or false worlds. While EUnetHTA is not alone in recommending the construction of imaginary worlds to support formulary decisions, there is still the opportunity to revisit these recommendations and decide whether or not to encourage a scientifically rigorous approach to health technology assessments - to abandon a commitment to intelligent design in favor of natural selection.  Conflict of Interest None   Type: Commentary  

PP65 Methods Applied For Systematic Reviews Of Economic Evaluations In Health Technology Assessment

2019 ◽  
Vol 35 (S1) ◽  
pp. 49-50
Author(s):  
Miriam Luhnen ◽  
Barbara Prediger ◽  
Edmund A.M. Neugebauer ◽  
Tim Mathes
Keyword(s):  
Health Technology Assessment ◽  
Systematic Reviews ◽  
Technology Assessment ◽  
Data Extraction ◽  
Reporting Quality ◽  
Health Technology ◽  
Economic Evaluations ◽  
Study Selection ◽  
Data Extraction Form ◽  
Literature Search Strategy

IntroductionWhen making decisions in health care, it is essential to consider economic evidence about an intervention. The objective of this study was to analyze the methods applied for systematic reviews of economic evaluations in Health Technology Assessment (HTA) and to identify common challenges.MethodsWe manually searched the webpages of HTA organizations and included HTA-reports published since 2015. Prerequisites for inclusion were the conduct of a systematic review of economic evaluations in at least one electronic database and the use of the English, German, French, or Spanish language. Methodological features were extracted in standardized tables. We prepared descriptive statistical (e.g., median, range) measures to describe the applied methods. Data were synthesized in a structured narrative way.ResultsEighty-three reports were included in the analysis. We identified inexplicable heterogeneity, particularly concerning literature search strategy, data extraction, assessment of quality, and applicability. Furthermore, process steps were often missing or reported in a nontransparent way. The use of a standardized data extraction form was indicated in one-third of reports (32 percent). Fifty-four percent of authors systematically appraised included studies. In 10 percent of reports, the applicability of included studies was assessed. Involvement of two reviewers was rarely reported for the study selection (43 percent), data extraction (28 percent), and quality assessment (39 percent).ConclusionsThe methods applied for systematic reviews of economic evaluations in HTA and their reporting quality are very heterogeneous. Efforts toward a detailed, standardized guidance for the preparation of systematic reviews of economic evaluations definitely seem necessary. A general harmonization and improvement of the applied methodology would increase their value for decision makers.

OP07 Real World Evidence: How Can It Improve Health Technology Assessment?

2018 ◽  
Vol 34 (S1) ◽  
pp. 2-3
Author(s):  
John Gillespie ◽  
Sebnem Erdol ◽  
Chris Foteff ◽  
Liesl Strachan
Keyword(s):  
Health Economic ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Real World ◽  
New Technologies ◽  
Eligible Patient ◽  
Cost Effective ◽  
Health Technology ◽  
Economic Evaluations ◽  
Patient Pathways

Introduction:Health Technology Assessment (HTA) considers the question of whether evaluated technologies are cost-effective in real world settings. As observed in HTA conducted by the Australian Medical Services Advisory Committee (MSAC), questions regarding the validity of data inputs to economic analyses that reflect real-world practice is a common reason for uncertainty on the cost effectiveness of new technologies. In addition to resource use and costs, there may be other uncertainties regarding the eligible patient population, patient management pathways and comparator selection. Our objective in this study was to present case studies from Australia where real world linked datasets could be better utilized to inform HTA conducted by the MSAC.Methods:For selected therapy areas, assessment reports and public summary documents of HTA conducted by the MSAC published between January 2015 and November 2017 were reviewed. Our analysis identified HTAs where uncertainties around the inputs for health economic evaluations, as well as uncertainties in defining eligible patient numbers or current patient pathways of care were shown to exist. We then explored whether these uncertainties could have been addressed through real world linked datasets.Results:Our preliminary investigations identified two assessments: MSAC assessment of capsule endoscopy and transcatheter aortic valve implantation - where availability of real world linked data could have addressed uncertainties around the inputs required for the health economic evaluations.Conclusions:Australia has a range of real world datasets with the potential to be used to inform HTA conducted by the MSAC. This can only be achieved if the datasets could be better linked and accessible for use by key stakeholders in the MSAC HTA process (e.g. industry, clinician, patient societies). Use of these data sets in HTA will enable timelier patient access to cost-effective technologies and more effective implementation and review of technologies after adoption into clinical practice.

scholarly journals WHICH DATABASES SHOULD BE USED TO IDENTIFY STUDIES FOR SYSTEMATIC REVIEWS OF ECONOMIC EVALUATIONS?

2018 ◽  
Vol 34 (6) ◽  
pp. 547-554 ◽  
Author(s):  
Mick Arber ◽  
Julie Glanville ◽  
Jaana Isojarvi ◽  
Erin Baragula ◽  
Mary Edwards ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Systematic Reviews ◽  
Technology Assessment ◽  
Gold Standard ◽  
Grey Literature ◽  
Health Technology ◽  
Search Strategies ◽  
Economic Evaluations ◽  
Medline Search ◽  
Mean Sensitivity

Objectives:This study investigated which databases and which combinations of databases should be used to identify economic evaluations (EEs) to inform systematic reviews. It also investigated the characteristics of studies not identified in database searches and evaluated the success of MEDLINE search strategies used within typical reviews in retrieving EEs in MEDLINE.Methods:A quasi-gold standard (QGS) set of EEs was collected from reviews of EEs. The number of QGS records found in nine databases was calculated and the most efficient combination of databases was determined. The number and characteristics of QGS records not retrieved from the databases were collected. Reproducible MEDLINE strategies from the reviews were rerun to calculate the sensitivity and precision for each strategy in finding QGS records.Results:The QGS comprised 351 records. Across all databases, 337/351 (96 percent) QGS records were identified. Embase yielded the most records (314; 89 percent). Four databases were needed to retrieve all 337 references: Embase + Health Technology Assessment database + (MEDLINE or PubMed) + Scopus. Four percent (14/351) of records could not be found in any database. Twenty-nine of forty-one (71 percent) reviews reported a reproducible MEDLINE strategy. Ten of twenty-nine (34.5 percent) of the strategies missed at least one QGS record in MEDLINE. Across all twenty-nine MEDLINE searches, 25/143 records were missed (17.5 percent). Mean sensitivity was 89 percent and mean precision was 1.6 percent.Conclusions:Searching beyond key databases for published EEs may be inefficient, providing the search strategies in those key databases are adequately sensitive. Additional search approaches should be used to identify unpublished evidence (grey literature).

OP141 Health Technology Assessment In India: Current Scenario And Way Forward

2020 ◽  
Vol 36 (S1) ◽  
pp. 1-2
Author(s):  
Komal Shah ◽  
Somen Saha ◽  
Priya Kotwani ◽  
Malkeet Singh ◽  
Kirti Tyagi
Keyword(s):  
Public Health ◽  
Cost Effectiveness ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Cochrane Library ◽  
Economic Evaluations ◽  
Healthcare Budget ◽  
Life Years ◽  
The Cost

IntroductionIndia has introduced health technology assessment (HTA) as a tool for improving the allocation of health resources. The core mandate of HTA in India (HTAIn) is to undertake critical appraisal of available technologies, identify cost-effective interventions, and help the government pursue evidence-informed decisions regarding public health expenditures. We conducted a systematic review to assess economic evaluation studies published in the last four years from India.MethodsEconomic evaluations published from September 2015 to September 2019 were identified by searching various databases, including PubMed, Scopus, Embase, The Cochrane Library, and CINAHL according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Cost-effectiveness studies and HTAs reported or conducted in India were included. Two independent reviewers performed the final selection of studies by assessing the full-text articles and conducted the data extraction. Differences of opinions were resolved through discussion and mutual consensus.ResultsAfter screening 2,837 articles, seventy met the inclusion criteria and were selected. The articles predominantly used secondary data (70%) to evaluate the cost effectiveness of an innovation. Among the technologies assessed, fifty-seven percent were curative in nature and most commonly addressed infectious diseases (27%), closely followed by non-communicable diseases, and maternal and child health. Principally, the cost effectiveness of a technology was expressed in terms of disability-adjusted or quality-adjusted life-years. Only two studies reported negative findings.ConclusionsHTA can play a pivotal role in equipping policy makers and public health payers to make appropriate decisions for healthcare budget allocations when mapped with the true disease burden of the population. It is important to highlight negative results and to create a national repository of HTA studies to facilitate faster adoption of best practices in India.

scholarly journals Health technology assessment in the United Kingdom

2009 ◽  
Vol 25 (S1) ◽  
pp. 178-181 ◽  
Author(s):  
Michael Drummond ◽  
David Banta
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Cost Effectiveness ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Clinical Excellence ◽  
Present Situation ◽  
Health Technology ◽  
The United Kingdom ◽  
Short Run

Objectives: The aim of this study was to describe generally the development and present situation with health technology assessment (HTA) in the United Kingdom.Methods: The methods used are a review of important materials that have described the development process and present situation, supplemented by some personal experiences.Results: The United Kingdom has been characterized historically as a country with a strong interest in evidence in health care, both clinical trials for efficacy and cost-effectiveness analyses. However, this evidence was not well-linked to the needs of the National Health Services (NHS) before formation of the NHS R&D Programme in 1991, The R&D Programme brought substantial resources into HTA and related activities, with the central aim of improving health care in Britain and increasing value for money. However, policy makers as well as staff of the R&D Programme were dissatisfied with the use of the HTA results in clinical and administrative practice. Therefore, the National Institute of Clinical Excellence (NICE) was formed in 1999. NICE issues guidance intended to influence practical decision making in health care at the national and local levels, based on efficacy information and, in some cases, economic analyses. NICE is now also seeking ways to maximize impacts on practice.Conclusions: The UK experience shows that information on clinical and cost-effectiveness may not be enough to change practice, at least in the short-run. Still, one may conclude that the United Kingdom now has one of the few most important and influential HTA programs in the world.

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