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Reed RL, Roeger L, Kaambwa B. Two-year follow-up of a clustered randomised controlled trial of a multicomponent general practice intervention for people at risk of poor health outcomes. BMC Health Serv Res 2024; 24:488. [PMID: 38641587 PMCID: PMC11031969 DOI: 10.1186/s12913-024-10799-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 02/28/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND This study was a two-year follow-up evaluation of health service use and the cost-effectiveness of a multicomponent general practice intervention targeted at people at high risk of poor health outcomes. METHODS A two-year follow-up study of a clustered randomised controlled trial was conducted in South Australia during 2018-19, recruiting 1044 patients from three cohorts: children; adults (aged 18-64 years with two or more chronic diseases); and older adults (aged ≥ 65 years). Intervention group practices (n = 10) provided a multicomponent general practice intervention for 12 months. The intervention comprised patient enrolment to a preferred general practitioner (GP), access to longer GP appointments and timely general practice follow-up after episodes of hospital care. Health service outcomes included hospital use, specialist services and pharmaceuticals. The economic evaluation was based on quality-adjusted life years (QALYs) calculated from EuroQoL 5 dimensions, 5 level utility scores and used an A$50,000 per QALY gained threshold for determining cost-effectiveness. RESULTS Over the two years, there were no statistically significant intervention effects for health service use. In the total sample, the mean total cost per patient was greater for the intervention than control group, but the number of QALYs gained in the intervention group was higher. The estimated incremental cost-effectiveness ratio (ICER) was A$18,211 per QALY gained, which is lower than the A$50,000 per QALY gained threshold used in Australia. However, the intervention's cost-effectiveness was shown to differ by cohort. For the adult cohort, the intervention was associated with higher costs and lower QALYs gained (vs the total cohort) and was not cost-effective. For the older adults cohort, the intervention was associated with lower costs (A$540 per patient), due primarily to lower hospital costs, and was more effective than usual care. CONCLUSIONS The positive cost-effectiveness results from the 24-month follow-up warrant replication in a study appropriately powered for outcomes such as hospital use, with an intervention period of at least two years, and targeted to older people at high risk of poor health outcomes.
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Affiliation(s)
- Richard L Reed
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Leigh Roeger
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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de Jong AJ, Shahid N, Zuidgeest MGP, Santa-Ana-Tellez Y, Hogervorst M, Goettsch W, Traore H, de Boer A, Gardarsdottir H. Opportunities and Challenges for Decentralized Clinical Trial Approaches: European Health Technology Assessment Perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:294-300. [PMID: 38043711 DOI: 10.1016/j.jval.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/17/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Decentralized clinical trial (DCT) approaches are clinical trials in which some or all trial activities take place closer to participants' proximities instead of a traditional investigative site. Data from DCTs may be used for clinical and economic evaluations by health technology assessment (HTA) bodies to support reimbursement decision making. This study aimed to explore the opportunities and challenges for DCT approaches from an HTA perspective by interviewing representatives from European HTA bodies. METHODS We conducted semistructured interviews with 25 European HTA representatives between September 2022 and February 2023, and transcripts were analyzed after thematic analysis. RESULTS Two main themes were identified from the data relating to (1) DCT approaches in HTA and (2) trial-level acceptance and relevance. Experience with assessing DCTs was limited and a variety of knowledge about DCTs was observed. The respondents recognized the opportunity of DCTs to reduce recall bias when participant-reported outcome data can be collected more frequently and conveniently from home. Concerns were expressed about the data quality when participants become responsible for data collection. Despite this challenge, the respondents recognized the potential of DCTs to increase the generalizability of results because data can be collected in a setting reflective of the everyday situation potentially from a more diverse participant group. CONCLUSIONS DCTs could generate relevant results for HTA decision making when data are collected in a real-world setting from a diverse participant group. Increased awareness of the opportunities and challenges could help HTA assessors in their appraisal of DCT approaches.
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Affiliation(s)
- Amos J de Jong
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Nadi Shahid
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mira G P Zuidgeest
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yared Santa-Ana-Tellez
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Milou Hogervorst
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Wim Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; National Healthcare Institute, Diemen, The Netherlands
| | | | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Division Laboratory and Pharmacy, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands; Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland.
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Maessen M, Fliedner MC, Gahl B, Maier M, Aebersold DM, Zwahlen S, Eychmüller S. An economic evaluation of an early palliative care intervention among patients with advanced cancer. Swiss Med Wkly 2024; 154:3591. [PMID: 38579309 DOI: 10.57187/s.3591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Early integration of palliative care into oncology care has shown positive effects on patient symptoms and quality of life. It may also reduce health care costs. However given the heterogeneity of settings and interventions and the lack of information on the minimally effective dose for influencing care utilisation and costs, it remains uncertain whether early palliative care reduces costs. OBJECTIVES We sought to determine whether an early palliative care intervention integrated in usual oncology care in a Swiss hospital setting reduced utilisation and costs of health care in the last month of life when compared with usual oncology care alone. METHODS We performed a cost-consequences analysis alongside a multicentre trial. We extracted costs from administrative health insurance data and health care utilisation from family caregiver surveys to compare two study arms: usual oncology care and usual oncology care plus the palliative care intervention. The intervention consisted of a single-structured, multiprofessional conversation with the patient about symptoms, end-of-life decisions, network building and support for carers (SENS). The early palliative care intervention was performed within 16 weeks of the diagnosis of a tumour stage not amenable or responsive to curative treatment. RESULTS We included 58 participants with advanced cancer in our economic evaluation study. Median overall health care costs in the last month of life were 7892 Swiss Francs (CHF) (interquartile range: CHF 5637-13,489) in the intervention arm and CHF 8492 [CHF 5411-12,012] in the control arm. The average total intervention treatment cost CHF 380 per patient. Integrating an early palliative care intervention into usual oncology care showed no significant difference in health care utilisation or overall health care costs between intervention and control arms (p = 0.98). CONCLUSION Although early palliative care is often presented as a cost-reducing care service, we could not show a significant effect of the SENS intervention on health care utilisation and costs in the last month of life. However, it may be that the intervention was not intensive enough, the timeframe too short or the study population too small for measurable effects. Patients appreciated the intervention. Single-structured early palliative care interventions are easy to implement in clinical practice and present low treatment costs. Further research about the economic impact of early palliative care should focus on extracting large, detailed cost databases showing potential shifts in cost and cost-effectiveness. CLINICAL TRIALS gov Identifier: NCT01983956.
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Affiliation(s)
- Maud Maessen
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- University Centre for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Monica C Fliedner
- University Centre for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Marina Maier
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Susanne Zwahlen
- Unit for Specialised Palliative Care, Lindenhof Hospital, Bern, Switzerland
| | - Steffen Eychmüller
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- University Centre for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Teng MJ, Zadro JR, Pickles K, Copp T, Shaw MJ, Khoudair I, Horsley M, Warnock B, Hutchings OR, Petchell JF, Ackerman IN, Drayton A, Liu R, Maher CG, Traeger AC. RECITAL: a non-inferiority randomised control trial evaluating a virtual fracture clinic compared with in-person care for people with simple fractures (study protocol). BMJ Open 2024; 14:e080800. [PMID: 38316591 PMCID: PMC10859974 DOI: 10.1136/bmjopen-2023-080800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Most simple undisplaced fractures can be managed without surgery by immobilising the limb with a splint, prescribing medication for pain, and providing advice and early rehabilitation. Recent systematic reviews based on retrospective observational studies have reported that virtual fracture clinics can deliver follow-up care that is safe and cost-effective. However, no randomised controlled trial has investigated if a virtual fracture clinic can provide non-inferior physical function outcomes compared with an in-person clinic for patients with simple fractures. METHODS AND ANALYSIS 312 participants will be recruited from 2 metropolitan hospitals located in Sydney, Australia. Adult patients will be eligible if they have an acute simple fracture that can be managed with a removable splint and is deemed appropriate for follow-up at either the virtual or in-person fracture clinic by an orthopaedic doctor. Patients will not be eligible if they have a complex fracture that requires a cast or surgery. Eligible participants will be randomised to receive their follow-up care either at the virtual or the in-person fracture clinic. Participants at the virtual fracture clinic will be reviewed within 5 days of receiving a referral through video calls with a physiotherapist. Participants at the in-person fracture clinic will be reviewed by an orthopaedic doctor within 7-10 days of receiving a referral. The primary outcome will be the patient's function measured using the Patient-Specific Functional Scale at 12 weeks. Secondary outcomes will include health-related quality of life, patient-reported experiences, pain, health cost, healthcare utilisation, medication use, adverse events, emergency department representations and surgery. ETHICS AND DISSEMINATION The study has been approved by the Sydney Local Health District Ethics Review Committee (RPAH Zone) (X23-0200 and 2023/ETH01038). The trial results will be submitted for publication in a reputable international journal and will be presented at professional conferences. TRIAL REGISTRATION NUMBER ACTRN12623000934640.
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Affiliation(s)
- Min Jiat Teng
- Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- RPA Virtual Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Kristen Pickles
- Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Tessa Copp
- Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Miranda J Shaw
- RPA Virtual Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Isabella Khoudair
- RPA Virtual Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mark Horsley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Benjamin Warnock
- RPA Virtual Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Owen R Hutchings
- RPA Virtual Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jeffrey F Petchell
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alison Drayton
- Consumer Representative, Sydney, New South Wales, Australia
| | - Rong Liu
- RPA Virtual Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- University of New South Wales, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Reuvers JRD, Gaikhorst E, Ben ÂJ, Scholten J, van Egmond M, Bosmans JE, Stockmann HBAC, Kazemier G, Tuynman JB, Abis GSA, Oosterling SJ. Cost-effectiveness of selective decontamination of the digestive tract to decrease infectious complications in colorectal cancer surgery: An analysis of the SELECT trial. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107116. [PMID: 37907018 DOI: 10.1016/j.ejso.2023.107116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Selective decontamination of the digestive tract (SDD) is effective in reducing infectious complications in elective colorectal cancer (CRC) surgery. However, it is unclear whether SDD is cost-effective compared to standard antibiotic prophylaxis. MATERIAL & METHODS Economic evaluation alongside multicenter randomized controlled trial, the SELECT-trial, from a healthcare perspective. Patients included underwent elective surgery for non-metastatic CRC. The intervention group received oral non-absorbable colistin, tobramycin and amphotericin B (SDD) next to standard antibiotic prophylaxis. Both groups received a single shot intravenous cefazolin and metronidazole preoperatively as standard prophylaxis. Occurrence of postoperative infectious complication in the first 30 postoperative days was extracted from medical records, Quality-Adjusted Life-Years (QALYs) based on the ED-5D-3L, and healthcare costs collected from the hospital's financial administration. RESULTS Of the 455 patients, 228 were randomly assigned to intervention group and 227 patients to the control group. SDD significantly reduced the number of infectious complications compared to control (difference = -0.13, 95 % CI -0.05 to -0.20). No difference was found for QALYs (difference = 0.002, 95 % CI -0.002 to 0.005). Healthcare costs were statistically significantly lower in the intervention group (difference = -€1258, 95 % CI -2751 to -166). The ICER was -9872 €/infectious complication prevented and -820,380 €/QALY gained. For all willingness-to-pay thresholds, the probability that prophylactic SDD was cost-effective compared to standard prophylactic practice alone was 1.0. CONCLUSION The addition of SDD to the standard preoperative intravenous antibiotic prophylaxis is cost-effective compared to standard prophylactic practice from a healthcare perspective and should be considered as the standard of care.
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Affiliation(s)
- J R D Reuvers
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands; Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1108, 1081, HZ, Amsterdam, the Netherlands; Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centers, De Boelelaan 1108, 1081, HZ, Amsterdam, the Netherlands.
| | - E Gaikhorst
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands; Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1108, 1081, HZ, Amsterdam, the Netherlands; Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centers, De Boelelaan 1108, 1081, HZ, Amsterdam, the Netherlands.
| | - Â Jornada Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands.
| | - J Scholten
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands.
| | - M van Egmond
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1108, 1081, HZ, Amsterdam, the Netherlands; Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centers, De Boelelaan 1108, 1081, HZ, Amsterdam, the Netherlands.
| | - J E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands.
| | - H B A C Stockmann
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands.
| | - G Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1108, 1081, HZ, Amsterdam, the Netherlands.
| | - J B Tuynman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University, De Boelelaan 1108, 1081, HZ, Amsterdam, the Netherlands.
| | - G S A Abis
- Department of Surgery, Meander Medical Centre, Maatweg 3, 3813, TZ, Amersfoort, the Netherlands.
| | - S J Oosterling
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands.
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Ben ÂJ, van Dongen JM, El Alili M, Esser JL, Broulíková HM, Bosmans JE. Conducting Trial-Based Economic Evaluations Using R: A Tutorial. PHARMACOECONOMICS 2023; 41:1403-1413. [PMID: 37458913 PMCID: PMC10570221 DOI: 10.1007/s40273-023-01301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 10/13/2023]
Abstract
Trial-based economic evaluations are increasingly being conducted to support healthcare decision-making. When analysing trial-based economic evaluation data, different methodological challenges may be encountered, including (i) missing data, (ii) correlated costs and effects, (iii) baseline imbalances and (iv) skewness of costs and/or effects. Despite the broad range of methods available to account for these methodological challenges in effectiveness studies, they may not always be directly applicable in trial-based economic evaluations where costs and effects are analysed jointly, and more than one methodological challenge typically needs to be addressed simultaneously. The use of inappropriate methods can bias results and conclusions regarding the cost-effectiveness of healthcare interventions. Eventually, such low-quality evidence can hamper healthcare decision-making, which may in turn result in a waste of already scarce healthcare resources. Therefore, this tutorial aims to provide step-by-step guidance on how to combine appropriate statistical methods for handling the abovementioned methodological challenges using a ready-to-use R script. The theoretical background of the described methods is provided, and their application is illustrated using a simulated trial-based economic evaluation.
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Affiliation(s)
- Ângela Jornada Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Mohamed El Alili
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Jonas L Esser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Hana Marie Broulíková
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Ng DS, Yip BHK, Young AL, Yip WWK, Lam NM, Li KK, Ko ST, Chan WH, Aryasit O, Sikder S, Ferris JD, Pang CP, Tham CC. Cost-effectiveness of virtual reality and wet laboratory cataract surgery simulation. Medicine (Baltimore) 2023; 102:e35067. [PMID: 37800761 PMCID: PMC10552957 DOI: 10.1097/md.0000000000035067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE To evaluate the cost-effectiveness of phacoemulsification simulation training in virtual reality simulator and wet laboratory on operating theater performance. METHODS Residents were randomized to a combination of virtual reality and wet laboratory phacoemulsification or wet laboratory phacoemulsification. A reference control group consisted of trainees who had wet laboratory training without phacoemulsification. All trainees were assessed on operating theater performance in 3 sequential cataract patients. International Council of Ophthalmology Surgical Competency Assessment Rubric-phacoemulsification (ICO OSCAR phaco) scores by 2 masked independent graders and cost data were used to determine the incremental cost-effectiveness ratio (ICER). A decision model was constructed to indicate the most cost-effective simulation training strategy based on the willingness to pay (WTP) per ICO OSCAR phaco score gained. RESULTS Twenty-two trainees who performed phacoemulsification in 66 patients were analyzed. Trainees who had additional virtual reality simulation achieved higher mean ICO OSCAR phaco scores compared with trainees who had wet laboratory phacoemulsification and control (49.5 ± standard deviation [SD] 9.8 vs 39.0 ± 15.8 vs 32.5 ± 12.1, P < .001). Compared with the control group, ICER per ICO OSCAR phaco of wet laboratory phacoemulsification was $13,473 for capital cost and $2209 for recurring cost. Compared with wet laboratory phacoemulsification, ICER per ICO OSCAR phaco of additional virtual reality simulator training was US $23,778 for capital cost and $1879 for recurring cost. The threshold WTP values per ICO OSCAR phaco score for combined virtual reality simulator and wet laboratory phacoemulsification to be most cost-effective was $22,500 for capital cost and $1850 for recurring cost. CONCLUSIONS Combining virtual reality simulator with wet laboratory phacoemulsification training is effective for skills transfer in the operating theater. Despite of the high capital cost of virtual reality simulator, its relatively low recurring cost is more favorable toward cost-effectiveness.
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Affiliation(s)
- Danny S. Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- Hong Kong Baptist Hospital, Hong Kong, China
| | - Benjamin H. K. Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Alvin L. Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
| | - Wilson W. K. Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
| | - Nai M. Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Kenneth K. Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- United Christian Hospital, Hong Kong, China
| | - Simon T. Ko
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | | | | | - Shameema Sikder
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - John D. Ferris
- Ophthalmology, Gloucestershire Hospitals, National Health Service Foundation Trust, Cheltenham, United Kingdom
| | - Chi P. Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
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Xie F, Shemilt I, Vale L, Ruiz F, Drummond MF, Lord J, Herrmann KH, Rojas MX, Zhang Y, Canelo-Aybar C, Alonso-Coello P, Shamliyan T, Schünemann HJ. GRADE guidance 23: considering cost-effectiveness evidence in moving from evidence to health-related recommendations. J Clin Epidemiol 2023; 162:135-144. [PMID: 37597696 DOI: 10.1016/j.jclinepi.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/28/2023] [Accepted: 08/02/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND This is the 23rd in a series of articles describing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the certainty of evidence and strength of recommendations for systematic reviews, health technology assessments, and clinical guideline development. OBJECTIVES We outline how resource utilization and cost-effectiveness analyses are integrated into health-related recommendations, using the GRADE Evidence to Decision (EtD) frameworks. STUDY DESIGN AND SETTING Through iterative discussions and refinement, in-person, and online meetings, and through e-mail communication, we developed draft guidance to incorporate economic evidence in the formulation of health-related recommendations. We developed scenarios to operationalize the guidance. We presented a summary of the results to members of the GRADE Economic Evaluation Project Group. RESULTS We describe how to estimate the cost of preventing (or achieving) an event to inform assessments of cost-effectiveness of alternative treatments, when there are no published economic evaluations. Evidence profiles and Summary of Findings tables based on systematic reviews of cost-effectiveness analyses can be created to provide top-level summaries of results and quality of multiple published economic evaluations. We also describe how this information could be integrated in GRADE's EtD frameworks to inform health-related recommendations. Three scenarios representing various levels of available cost-effectiveness evidence were used to illustrate the integration process. CONCLUSION This GRADE guidance provides practical information for presenting cost-effectiveness data and its integration in the development of health-related recommendations, using the EtD frameworks.
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Affiliation(s)
- Feng Xie
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada; Faculty of Health Sciences, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada.
| | - Ian Shemilt
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; EPPI-Centre, University College London, 10 Woburn Square, London, WC1H 0NR, United Kingdom
| | - Luke Vale
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; Health Economics Group, Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Francis Ruiz
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Michael F Drummond
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; Centre for Health Economics, University of York, Alcuin 'A' Block, Heslington, York YO10 5DD, United Kingdom
| | - Joanne Lord
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; Southampton Health Technology Assessments Centre, University of Southampton, 1st Floor, Epsilon House, Enterprise Road Southampton Science Park, Southampton, SO16 7NS, United Kingdom
| | - Kirsten H Herrmann
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; ResearchGCP, Dunantstr.5, 85521 Ottobrunn, Germany
| | - María Ximena Rojas
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau, (IIB Sant Pau), Barcelona, Spain
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Carlos Canelo-Aybar
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau, (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau, (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Tatyana Shamliyan
- American College of Physicians, 190 N Independence Mall West, Philadelphia, PA, USA, 19106
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milano, Italy.
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9
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Dams J, Zapp JJ, König HH. Modelling the Cost Effectiveness of Treatments for Parkinson's Disease: An Updated Methodological Review. PHARMACOECONOMICS 2023; 41:1205-1228. [PMID: 37344724 PMCID: PMC10492764 DOI: 10.1007/s40273-023-01289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE This article systematically reviewed the methodological quality of modelling approaches for economic evaluations of the treatment of motor symptoms in Parkinson's disease in studies published after 2010. METHODS A systematic literature search was undertaken using PubMed, EconLit, the Cochrane Database of Systematic Reviews, National Health Service Economic Evaluation Database and Health Technology Assessment databases of the UK National Health Service Centre for Review and Dissemination (March 2010 to July 2022). Quality was assessed using a checklist from the German Scientific Working Group. RESULTS A total of 20 studies were evaluated, with the majority based on Markov models (n = 18). Studies assessed the cost effectiveness of medical (n = 12) or surgical (n = 8) treatment, and included costs from a payer or healthcare provider's perspective (n = 17). Furthermore, all studies included quality-adjusted life-years as an effect measure. In the quality assessment of the literature, a mean score of 42.1 points (out of 56 points) on the checklist of the German Scientific Working Group was achieved. Seventeen studies concluded the intervention under study was (likely) cost effective. No intervention was classified as cost ineffective. CONCLUSIONS The quality of economic evaluation models in Parkinson's disease has improved in terms of calculating cost and transition parameters, as well as carrying out probabilistic sensitivity analyses, compared with the published literature of previous systematic reviews up to 2010. However, there is still potential for further development in terms of the integration of non-motor complications and treatment changes, the transparent presentation of parameter estimates, as well as conducting sensitivity analyses and validations to support the interpretation of results.
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Affiliation(s)
- Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany.
| | - Johann-Jacob Zapp
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany
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10
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McCarthy A, Samarakoon D, Gray J, Mcmeekin P, McCarthy S, Newton C, Nobbenhuis M, Lippiatt J, Twigg J. Robotic and laparoscopic gynaecological surgery: a prospective multicentre observational cohort study and economic evaluation in England. BMJ Open 2023; 13:e073990. [PMID: 37770262 PMCID: PMC10546163 DOI: 10.1136/bmjopen-2023-073990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/06/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE To compare the health-related quality of life and cost-effectiveness of robot-assisted laparoscopic surgery (RALS) versus conventional 'straight stick' laparoscopic surgery (CLS) in women undergoing hysterectomy as part of their treatment for either suspected or proven gynaecological malignancy. DESIGN Multicentre prospective observational cohort study. SETTING Patients aged 16+ undergoing hysterectomy as part of their treatment for gynaecological malignancy at 12 National Health Service (NHS) cancer units and centres in England between August 2017 and February 2020. PARTICIPANTS 275 patients recruited with 159 RALS, 73 CLS eligible for analysis. OUTCOME MEASURES Primary outcome was the European Organisation for Research and Treatment of Cancer Quality of Life measure (EORTC). Secondary outcomes included EuroQol-5 Dimension (EQ-5D-5L) utility, 6-minute walk test (6MWT), NHS costs using pounds sterling (£) 2018-2019 prices and cost-effectiveness. The cost-effectiveness evaluation compared EQ-5D-5L quality adjusted life years and costs between RALS and CLS. RESULTS No difference identified between RALS and CLS for EORTC, EQ-5D-5L utility and 6MWT. RALS had unadjusted mean cost difference of £556 (95% CI -£314 to £1315) versus CLS and mean quality adjusted life year (QALY) difference of 0.0024 (95% CI -0.00051 to 0.0057), non-parametric incremental cost-effectiveness ratio of £231 667per QALY. For the adjusted cost-effectiveness analysis, RALS dominated CLS with a mean cost difference of -£188 (95% CI -£1321 to £827) and QALY difference of 0.0024 (95% CI -0.0008 to 0.0057). CONCLUSIONS Findings suggest that RALS versus CLS in women undergoing hysterectomy (after adjusting for differences in morbidity) is cost-effective with lower costs and QALYs. Results are highly sensitive to the usage of robotic hardware with higher usage increasing the probability of cost-effectiveness. Non-inferiority randomised controlled trial would be of benefit to decision-makers to provide further evidence on the cost-effectiveness of RALS versus CLS but may not be practical due to surgical preferences of surgeons and the extensive roll out of RALS.
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Affiliation(s)
- Andrew McCarthy
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Dilupa Samarakoon
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Joanne Gray
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Peter Mcmeekin
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Stephen McCarthy
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Claire Newton
- Department of Gynaecology Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Marielle Nobbenhuis
- Department of Gynaecological Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Jonathan Lippiatt
- Department of Gynaecological Oncology, University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Jeremy Twigg
- Department of Gynaecological Oncology, Coventry and Warwickshire Hospital, Coventry, UK
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11
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Chen BK, Dunsiger SI, Pinto BM. Cost-effectiveness of peer-delivered physical activity promotion and maintenance programs for initially sedentary breast cancer survivors. Transl Behav Med 2023; 13:683-693. [PMID: 37155603 PMCID: PMC10496440 DOI: 10.1093/tbm/ibad026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The evidence for the survival and health benefits of physical activity (PA) among cancer survivors is well documented. However, it has been challenging to maintain PA among cancer survivors. To evaluate the cost-effectiveness of peer support to encourage maintenance of moderate-to-vigorous physical activity (MVPA) among breast cancer survivors. Participants were randomized into Reach Plus Message (weekly text/email messages), Reach Plus Phone (monthly phone calls) or Reach Plus (a self-monitoring intervention) over 6 months after an initial adoption phase. We calculated the incremental cost-effectiveness ratios (ICER) in terms of quality-adjusted years life years (QALYs) and self-reported MVPA, from the payer's budgetary and societal perspectives over 1 year. Intervention costs were collected via time logs from the trainers and peer coaches, and participant costs from the participants via surveys. For our sensitivity analyses, we bootstrapped costs and effects to construct cost-effectiveness planes and acceptability curves. The intervention that provides weekly messages from peer coaches has an ICER of $14,446 per QALY gained and $0.95 per extra minute of MVPA per day over Reach Plus. Reach Plus Message has a 49.8% and 78.5% probability of cost-effectiveness respectively when decision makers are willing to pay approximately $25,000 per QALY and $10 per additional minute of MVPA. Reach Plus Phone, which requires tailored monthly telephone calls, costs more than Reach Plus Message but yields less QALY and self-reported MVPA at 1 year. Reach Plus Message may be a viable and cost-effective intervention strategy to maintain MVPA among breast cancer survivors.
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Affiliation(s)
- Brian K Chen
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, 915 Green Street Suite 354, Columbia, SC 29208, USA
| | - Shira I Dunsiger
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University, Box G-121-8 Providence, RI 02912, USA
| | - Bernardine M Pinto
- Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Room 302B, Columbia, SC 29208, USA
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12
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De Rooij L, Kimman ML, Spiekerman van Weezelenburg MA, van Kuijk SMJ, Granzier RWY, Hintzen KFH, Heymans C, Theunissen LLB, van Haaren ERM, Janssen A, Vissers YLJ, Beets GL, van Bastelaar J. Economic evaluation of flap fixation techniques after mastectomy: Results of a double-blind randomized controlled trial (SAM-trial). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107003. [PMID: 37542999 DOI: 10.1016/j.ejso.2023.107003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND An economic evaluation was performed alongside an RCT investigating flap fixation in reducing seroma formation after mastectomy. The evaluation focused on the first year following mastectomy and assessed cost-effectiveness from a health care and societal perspective. METHODS The economic evaluation was conducted between 2014 and 2018 in four Dutch breast clinics. Patients with an indication for mastectomy or modified radical mastectomy were randomly assigned to: conventional closure (CON), flap fixation with sutures (FFS) or flap fixation with tissue glue (FFG). Health care costs, patient and family costs and costs due to productivity losses were assessed. Outcomes were expressed in incremental cost-effectiveness ratios (ICERs): the incremental cost per quality-adjusted life year (QALY). Bootstrapping techniques, sensitivity and secondary analyses were employed to address uncertainty. RESULTS The FFS-group yielded most QALYs (0.810; 95%-CI 0.755-0.856), but also incurred the highest mean costs at twelve months (€10.416; 95%-CI 8.231-12.930). CON was the next best alternative with 0.794 QALYs (95%-CI 0.733-0.841) and mean annual costs of €10.051 (95%-CI 8.255-12.044). FFG incurred fewer QALYs and higher costs, when compared to the CON group. The ICER of FFS compared to CON was €22.813/QALY. Applying a willingness to pay threshold in the Netherlands of €20.000/QALY, the probability that FFS was cost-effective was 42%, compared to 37% and 21% for CON and FFG, respectively. CONCLUSION The cost-effectiveness of FFS following mastectomy, versus CON and FFG, is uncertain from a societal perspective. Yet, from a health care and hospital perspective FFS is likely to be the most cost-effective intervention.
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Affiliation(s)
- L De Rooij
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R W Y Granzier
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - K F H Hintzen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - C Heymans
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - L L B Theunissen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - E R M van Haaren
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - A Janssen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - Y L J Vissers
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - G L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - J van Bastelaar
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
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13
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Hollingworth SA, Leaupepe GA, Nonvignon J, Fenny AP, Odame EA, Ruiz F. Economic evaluations of non-communicable diseases conducted in Sub-Saharan Africa: a critical review of data sources. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:57. [PMID: 37641087 PMCID: PMC10463745 DOI: 10.1186/s12962-023-00471-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Policymakers in sub-Saharan Africa (SSA) face challenging decisions regarding the allocation of health resources. Economic evaluations can help decision makers to determine which health interventions should be funded and or included in their benefits package. A major problem is whether the evaluations incorporated data from sources that are reliable and relevant to the country of interest. We aimed to review the quality of the data sources used in all published economic evaluations for cardiovascular disease and diabetes in SSA. METHODS We systematically searched selected databases for all published economic evaluations for CVD and diabetes in SSA. We modified a hierarchy of data sources and used a reference case to measure the adherence to reporting and methodological characteristics, and descriptively analysed author statements. RESULTS From 7,297 articles retrieved from the search, we selected 35 for study inclusion. Most were modelled evaluations and almost all focused on pharmacological interventions. The studies adhered to the reporting standards but were less adherent to the methodological standards. The quality of data sources varied. The quality level of evidence in the data domains of resource use and costs were generally considered of high quality, with studies often sourcing information from reliable databases within the same jurisdiction. The authors of most studies referred to data sources in the discussion section of the publications highlighting the challenges of obtaining good quality and locally relevant data. CONCLUSIONS The data sources in some domains are considered high quality but there remains a need to make substantial improvements in the methodological adherence and overall quality of data sources to provide evidence that is sufficiently robust to support decision making in SSA within the context of UHC and health benefits plans. Many SSA governments will need to strengthen and build their capacity to conduct economic evaluations of interventions and health technology assessment for improved priority setting. This capacity building includes enhancing local infrastructures for routine data production and management. If many of the policy makers are using economic evaluations to guide resource allocation, it is imperative that the evidence used is of the feasibly highest quality.
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Affiliation(s)
| | | | | | - Ama Pokuaa Fenny
- Institute of Social, Statistical and Economic Research, University of Ghana, Accra, Ghana
| | - Emmanuel A Odame
- Dept of Medical Affairs, Korle Bu Teaching Hospital, Accra, Ghana
| | - Francis Ruiz
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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14
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Zhang X, Wu K, Pan Y, Yin R, Zhang Y, Kong D, Wang Q, Chen W. Optimized segmented regression models for the transition period of intervention effects. Glob Health Res Policy 2023; 8:29. [PMID: 37482607 PMCID: PMC10364415 DOI: 10.1186/s41256-023-00312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND The interrupted time series (ITS) design is a widely used approach to examine the effects of interventions. However, the classic segmented regression (CSR) method, the most popular statistical technique for analyzing ITS data, may not be adequate when there is a transitional period between the pre- and post-intervention phases. METHODS To address this issue and better capture the distribution patterns of intervention effects during the transition period, we propose using different cumulative distribution functions in the CSR model and developing corresponding optimized segmented regression (OSR) models. This study illustrates the application of OSR models to estimate the long-term impact of a national free delivery service policy intervention in Ethiopia. RESULTS Regardless of the choice of transition length ([Formula: see text]) and distribution patterns of intervention effects, the OSR models outperformed the CSR model in terms of mean square error (MSE), indicating the existence of a transition period and the validity of our model's assumptions. However, the estimates of long-term impacts using OSR models are sensitive to the selection of L, highlighting the importance of reasonable parameter specification. We propose a data-driven approach to select the transition period length to address this issue. CONCLUSIONS Overall, our OSR models provide a powerful tool for modeling intervention effects during the transition period, with a superior model fit and more accurate estimates of long-term impacts. Our study highlights the importance of appropriate statistical methods for analyzing ITS data and provides a useful framework for future research.
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Affiliation(s)
- Xiangliang Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Kunpeng Wu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Yan Pan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Rong Yin
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Yi Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Di Kong
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Qi Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China.
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15
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Wiethoff I, Evers SMAA, Michels M, Hiligsmann M. An introduction to health technology assessment and health economic evaluation: an online self-learning course. Neth Heart J 2023; 31:219-225. [PMID: 37171709 DOI: 10.1007/s12471-023-01777-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 05/13/2023] Open
Abstract
Cardiovascular diseases impose an enormous burden on patients and society. New health technologies promise to lower this burden; however, novel treatments often come at a high cost. In the Netherlands, health technology assessment (HTA) is increasingly being used to inform policy bodies about the optimal distribution of scarce healthcare resources and to guide decision-making about financing and reimbursement. In particular, economic evaluations, as one pillar of HTA, are frequently used to compare the costs and effects of different interventions. This paper aims to define HTA and its relevance to healthcare policy as well as providing a comprehensive overview of the methodology of economic evaluations targeting health professionals and researchers with limited prior knowledge of this subject. Accordingly, different types of economic evaluations are introduced, together with their respective costs and outcomes. Further, the results of economic evaluations are explained, along with techniques for performing them and methods for coping with uncertainty. In addition to this paper-based learning format, each chapter is complemented by a video lecture with further information and practical examples, helping to better understand and analyse health economic studies.
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Affiliation(s)
- Isabell Wiethoff
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Al-Najjar N, Bray L, Carter B, Castle AP, Collingwood A, Cook G, Crudgington H, Currier J, Dietz KC, Hardy WAS, Hiscock H, Hughes D, Morris C, Roberts D, Rouncefield-Swales A, Saron H, Spowart C, Stibbs-Eaton L, Tudur Smith C, Watson V, Whittle L, Wiggs L, Wood E, Gringras P, Pal DK. Changing Agendas on Sleep, Treatment and Learning in Epilepsy (CASTLE) Sleep-E: a protocol for a randomised controlled trial comparing an online behavioural sleep intervention with standard care in children with Rolandic epilepsy. BMJ Open 2023; 13:e065769. [PMID: 36898757 PMCID: PMC10008377 DOI: 10.1136/bmjopen-2022-065769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION Sleep and epilepsy have an established bidirectional relationship yet only one randomised controlled clinical trial has assessed the effectiveness of behavioural sleep interventions for children with epilepsy. The intervention was successful, but was delivered via face-to-face educational sessions with parents, which are costly and non-scalable to population level. The Changing Agendas on Sleep, Treatment and Learning in Epilepsy (CASTLE) Sleep-E trial addresses this problem by comparing clinical and cost-effectiveness in children with Rolandic epilepsy between standard care (SC) and SC augmented with a novel, tailored parent-led CASTLE Online Sleep Intervention (COSI) that incorporates evidence-based behavioural components. METHODS AND ANALYSES CASTLE Sleep-E is a UK-based, multicentre, open-label, active concurrent control, randomised, parallel-group, pragmatic superiority trial. A total of 110 children with Rolandic epilepsy will be recruited in outpatient clinics and allocated 1:1 to SC or SC augmented with COSI (SC+COSI). Primary clinical outcome is parent-reported sleep problem score (Children's Sleep Habits Questionnaire). Primary health economic outcome is the incremental cost-effectiveness ratio (National Health Service and Personal Social Services perspective, Child Health Utility 9D Instrument). Parents and children (≥7 years) can opt into qualitative interviews and activities to share their experiences and perceptions of trial participation and managing sleep with Rolandic epilepsy. ETHICS AND DISSEMINATION The CASTLE Sleep-E protocol was approved by the Health Research Authority East Midlands (HRA)-Nottingham 1 Research Ethics Committee (reference: 21/EM/0205). Trial results will be disseminated to scientific audiences, families, professional groups, managers, commissioners and policymakers. Pseudo-anonymised individual patient data will be made available after dissemination on reasonable request. TRIAL REGISTRATION NUMBER ISRCTN13202325.
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Affiliation(s)
- Nadia Al-Najjar
- Liverpool Clinical Trials Centre, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Lucy Bray
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Bernie Carter
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Advisory Panel Castle
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Amber Collingwood
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Georgia Cook
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Holly Crudgington
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Janet Currier
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Kristina Charlotte Dietz
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Will A S Hardy
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Harriet Hiscock
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Christopher Morris
- University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Deborah Roberts
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Alison Rouncefield-Swales
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Holly Saron
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Catherine Spowart
- Liverpool Clinical Trials Centre, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Lucy Stibbs-Eaton
- Liverpool Clinical Trials Centre, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Catrin Tudur Smith
- Department of Health Data Science, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Victoria Watson
- Department of Health Data Science, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Liam Whittle
- Department of Health Data Science, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Luci Wiggs
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Paul Gringras
- Department of Sleep Medicine, Evelina London Children's Hospital, London, UK
| | - Deb K Pal
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Van Lieshout RJ, Layton H, Savoy CD, Xie F, Brown JSL, Huh K, Bieling PJ, Streiner DL, Ferro MA, Haber-Evans E. In-person 1-day cognitive behavioral therapy-based workshops for postpartum depression: a randomized controlled trial. Psychol Med 2023; 53:1-11. [PMID: 36878891 PMCID: PMC10600825 DOI: 10.1017/s0033291723000454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Postpartum depression (PPD) affects up to one in five mothers and birthing parents, yet as few as 10% access evidence-based treatment. One-day cognitive behavioral therapy (CBT)-based workshops for PPD have the potential to reach large numbers of sufferers and be integrated into stepped models of care. METHODS This randomized controlled trial of 461 mothers and birthing parents in Ontario, Canada with Edinburgh Postnatal Depression Scale (EPDS) scores ⩾10, age ⩾18 years, and an infant <12 months of age compared the effects of a 1-day CBT-based workshop plus treatment as usual (TAU; i.e. care from any provider(s) they wished) to TAU alone at 12-weeks post-intervention on PPD, anxiety, the mother-infant relationship, offspring behavior, health-related quality of life, and cost-effectiveness. Data were collected via REDCap. RESULTS Workshops led to meaningful reductions in EPDS scores (m = 15.77 to 11.22; b = -4.6, p < 0.01) and were associated with three times higher odds of a clinically significant decrease in PPD [odds ratio (OR) 3.00, 95% confidence interval (CI) 1.93-4.67]. Anxiety also decreased and participants had three times the odds of clinically significant improvement (OR 3.20, 95% CI 2.03-5.04). Participants reported improvements in mother-infant bonding, infant-focused rejection and anger, and effortful control in their toddlers. The workshop plus TAU achieved similar quality-adjusted life-years at lower costs than TAU alone. CONCLUSIONS One-day CBT-based workshops for PPD can lead to improvements in depression, anxiety, and the mother-infant relationship and are cost-saving. This intervention could represent a perinatal-specific option that can treat larger numbers of individuals and be integrated into stepped care approaches at reasonable cost.
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Affiliation(s)
- Ryan J. Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Haley Layton
- Health Research Methodology Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Calan D. Savoy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - June S. L. Brown
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kathryn Huh
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Peter J. Bieling
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - David L. Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Mark A. Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Erika Haber-Evans
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Giorgi MA, Boissonnet CP, Luque PS, Piastrella J, Porley C, Ditata F, Volman S. Cost-effectiveness in unstable economies: the case of sacubitril/valsartan in heart failure with reduced ejection fraction in Argentina. HEALTH ECONOMICS REVIEW 2023; 13:13. [PMID: 36808581 PMCID: PMC9938575 DOI: 10.1186/s13561-023-00427-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Sacubitril/valsartan (an Angiotensin receptor-neprilysin inhibitor-ARNI) is one of the cornerstones in the management of patients with heart failure with reduced ejection fraction (HFrEF) having demonstrated significant reductions in both mortality and hospitalisations as compared with enalapril. It proved to be a cost-effective treatment in many countries with stable economies. In Argentina, a country with chronic financial instability and a fragmented health care system, the estimation of its cost-effectiveness requires to consider local financial data. OBJECTIVES To estimate the cost-effectiveness of sacubitril/valsartan in HFrEF in Argentina. METHODS We populated an Excel-based cost-effectiveness model, previously validated, using inputs from the pivotal phase-3 PARADIGM-HF trial and from local sources. As the main problem to consider was the financial instability, we adopted a differential approach to cost discounting based on the opportunity cost of capital. Thus, a discount rate for costs were set at 31.6%, using the BADLAR rate published by the Central Bank of Argentina. Discount for effects were set at 5% as is the current practice. Costs were expressed in Argentinian pesos (ARS). We used the perspective for both the social security and private payers at a 30-year horizon. The primary analysis was the incremental cost-effectiveness ratio (ICER) versus enalapril, the previous standard of care. Alternative scenarios performed included a 5% cost discount rate and 3 a 5-year horizon (as is usually used). RESULTS In Argentina the cost-per quality adjusted life-year (QALY) gained for sacubitril/valsartan versus enalapril was 391,158 ARS and 376,665 ARS for a social security and a private payer, respectively, at a 30- year horizon. These ICERs were under the cost- effectiveness threshold of 520,405.79 ARS (1 Gross domestic product (GDP) per capita) suggested by Argentinian health technology assessment bodies. Probabilistic sensitivity analysis showed an acceptability of sacubitril/valsartan as a cost-effective alternative of 86.40% and 88.25% for social security and private payers, respectively. CONCLUSION Sacubitril/valsartan is a cost-effective treatment in HFrEF using local inputs that considered the financial instability. For both payers considered the cost per QALY gained are under the cost-effectiveness threshold considered.
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Affiliation(s)
- Mariano A Giorgi
- Health Economics and Technology Assessment Unit. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Instituto Universitario CEMIC (IUC), Buenos Aires, Argentina
- Cardiology Section. Department of Internal Medicine. Centro de Educación Médica e Investigaciones Clínicas, Norberto Quirno" (CEMIC), Buenos Aires, Argentina
- Associate Professor of Pharmacology, Instituto Universitario CEMIC (IUC), Buenos Aires, Argentina
| | - Carlos P Boissonnet
- Health Economics and Technology Assessment Unit. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Instituto Universitario CEMIC (IUC), Buenos Aires, Argentina
- Cardiology Section. Department of Internal Medicine. Centro de Educación Médica e Investigaciones Clínicas, Norberto Quirno" (CEMIC), Buenos Aires, Argentina
| | | | - Jimena Piastrella
- Piastrella Worked at Novartis at the Time This Research Was Conducted, Basel, Switzerland
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19
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Hannah LA, Walsh CM, Jopling L, Perez J, Cardinal RN, Cameron RA. Economic evaluation of interventions for treatment-resistant depression: A systematic review. Front Psychiatry 2023; 14:1056210. [PMID: 36873195 PMCID: PMC9979220 DOI: 10.3389/fpsyt.2023.1056210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
Background The extraordinarily high prevalence of treatment-resistant depression (TRD), coupled with its high economic burden to both healthcare systems and society, underscore how critical it is that resources are managed optimally to address the significant challenge it presents. Objective To review the literature on economic evaluation in TRD systematically, with the aim of informing future studies by identifying key challenges specific to the area, and highlighting good practices. Methods A systematic literature search across seven electronic databases was conducted to identify both within-trial and model-based economic evaluations in TRD. Quality of reporting and study design was assessed using the Consensus Health Economic Criteria (CHEC). A narrative synthesis was conducted. Results We identified 31 evaluations, including 11 conducted alongside a clinical trial and 20 model-based evaluations. There was considerable heterogeneity in the definition of treatment-resistant depression, although with a trend for more recent studies to use a definition of inadequate response to two or more antidepressive treatments. A broad range of interventions were considered, including non-pharmacological neuromodulation, pharmacological, psychological, and service-level interventions. Study quality as assessed by CHEC was generally high. Frequently poorly reported items related to discussion of ethical and distributional issues, and model validation. Most evaluations considered comparable core clinical outcomes - encompassing remission, response, and relapse. There was good agreement on the definitions and thresholds for these outcomes, and a relatively small pool of outcome measures were used. Resource criteria used to inform the estimation of direct costs, were reasonably uniform. Predominantly, however, there was a high level of heterogeneity in terms of evaluation design and sophistication, quality of evidence used (particularly health state utility data), time horizon, population considered, and cost perspective. Conclusion Economic evidence for interventions in TRD is underdeveloped, particularly so for service-level interventions. Where evidence does exist, it is hampered by inconsistency in study design, methodological quality, and availability of high quality long-term outcomes evidence. This review identifies a number of key considerations and challenges for the design of future economic evaluations. Recommendations for research and suggestions for good practice are made. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259848&VersionID=1542096, identifier CRD42021259848.
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Affiliation(s)
- Laura A. Hannah
- Applied Research Collaboration East of England, National Institute for Health and Care Research, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Cathy M. Walsh
- Applied Research Collaboration East of England, National Institute for Health and Care Research, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Louise Jopling
- Eastern Academic Health Science Network, Cambridge, United Kingdom
| | - Jesus Perez
- Applied Research Collaboration East of England, National Institute for Health and Care Research, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Psychiatry Unit, Department of Medicine, Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
| | - Rudolf N. Cardinal
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Rory A. Cameron
- Applied Research Collaboration East of England, National Institute for Health and Care Research, Cambridge, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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20
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Bock LA, Noben CY, van Mook WN, de Ridder IR, van Zwam WH, Schenck HE, Haeren RH, Essers BA. Endovascular treatment and neurosurgical clipping in subarachnoid hemorrhage: a systematic review of economic evaluations. J Neurosurg Sci 2023; 67:18-25. [PMID: 35147403 DOI: 10.23736/s0390-5616.21.05503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION There are two treatment modalities for aneurysmal subarachnoid hemorrhage: endovascular treatment (EVT) and neurosurgical clipping. Results of economic evaluations are needed to gain insight into the relationship between clinical effectiveness and costs of these treatment modalities. This important information can inform both clinical decision-making processes and policymakers in facilitating Value-Based Healthcare. EVIDENCE ACQUISITION Databases (PubMed, Embase, Cochrane Library, the Centre for Reviews and Dissemination, EBSCO, and Web of Science) were searched for studies published until October 2020 that had performed economic evaluations in aneurysmal subarachnoid hemorrhage patients by comparing EVT with neurosurgical clipping. The quality of reporting and methodology of these evaluations was assessed using the associated instruments (i.e. CHEERS statement and CHEC-list, respectively). EVIDENCE SYNTHESIS A total of 6 studies met the inclusion criteria. All included studies reported both effects and costs, however five did not relate effects to costs. Only one study related effects directly to costs, thus conducted a full economic evaluation. The reporting quality scored 81% and the methodological quality scored 30%. CONCLUSIONS The quality of published cost-effectiveness studies on the treatment of aneurysmal subarachnoid hemorrhage is poor. Six studies reported both outcomes and costs, however only one study performed a full economic evaluation comparing EVT to neurosurgical clipping. Although the reporting quality was sufficient, the methodological quality was poor. Further research that relates health-related quality of life measures to costs of EVT and neurosurgical clipping is required - specifically focusing on both reporting and methodological quality. Different subgroup analyses and modeling could also enhance the findings.
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Affiliation(s)
- Lotte A Bock
- Academy of Postgraduate Medical Education, Maastricht University Medical Center, Maastricht, the Netherlands - .,School of Health Professions Education, University of Maastricht, Maastricht, the Netherlands -
| | - Cindy Y Noben
- Academy of Postgraduate Medical Education, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Walther N van Mook
- Academy of Postgraduate Medical Education, Maastricht University Medical Center, Maastricht, the Netherlands.,School of Health Professions Education, University of Maastricht, Maastricht, the Netherlands.,Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Inger R de Ridder
- Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Hanna E Schenck
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Roel H Haeren
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Brigitte A Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
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21
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Izumi S, Hagiwara Y, Matsuyama Y, Shiroiwa T, Taira N, Kawahara T, Konomura K, Noto S, Fukuda T, Shimozuma K. Impacts of the preceding cancer-specific health-related quality of life instruments on the responses to the subsequent EQ-5D-5L. Health Qual Life Outcomes 2023; 21:3. [PMID: 36650539 PMCID: PMC9843919 DOI: 10.1186/s12955-022-02085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In clinical studies, the EQ-5D-5L is often employed with disease-specific health-related quality of life instruments. The questions in the former are more general than the latter; however, it is known that responses to general questions can be influenced by preceding specific questions. Thus, the responses to the EQ-5D-5L have the possibility of being influenced by the preceding disease-specific health-related quality of life instruments. This may lead to bias in the cost-effectiveness analysis results. Therefore, this study aimed to evaluate the impact of the preceding cancer-specific health-related quality of life instruments on the EQ-5D-5L responses. METHODS We prepared questionnaire booklets containing the EQ-5D-5L, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and the Functional Assessment of Cancer Therapy General with different orders. Using a quasi-randomized design, they were distributed to the patients undergoing drug therapy for advanced cancer, who were classified into three groups: Groups 1, 2, and 3 (the EQ-5D-5L placed first, second, and last, respectively). We compared the EQ-5D-5L index and the missingness of EQ-5D-5L among the groups. RESULTS The mean EQ-5D-5L index was 0.796, 0.760, and 0.789 for groups 1 (n = 300), 2 (n = 306), and 3 (n = 331), respectively. The difference between Groups 2 and 1 was - 0.036 (95% CI - 0.065 to - 0.007; p = 0.015). The proportion of patients with an incomplete EQ-5D-5L was 0.11, 0.11, and 0.05 for Groups 1, 2, and 3, respectively. The difference of the proportions between group 3 and 1 and between 3 and 2 was - 0.06 (95% CI - 0.10 to - 0.02; p = 0.003) and - 0.06 (95% CI - 0.10 to - 0.02; p = 0.003), respectively. CONCLUSIONS Although the EQ-5D-5L index differed according to the instrument orders, the difference size would not be considerably larger than the minimally important difference. The patients tended to complete the EQ-5D-5L when they were placed at the end of the questionnaire.
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Affiliation(s)
- Shoki Izumi
- grid.26999.3d0000 0001 2151 536XBiostatistics and Bioinformatics Course, Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Hagiwara
- grid.26999.3d0000 0001 2151 536XDepartment of Biostatistics, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Yutaka Matsuyama
- grid.26999.3d0000 0001 2151 536XDepartment of Biostatistics, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Takeru Shiroiwa
- grid.415776.60000 0001 2037 6433Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Naruto Taira
- grid.412342.20000 0004 0631 9477Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Takuya Kawahara
- grid.412708.80000 0004 1764 7572Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Keiko Konomura
- grid.415776.60000 0001 2037 6433Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Shinichi Noto
- grid.412183.d0000 0004 0635 1290Center for Health Economics and QOL Research, Niigata University of Health and Welfare, Niigata, Japan
| | - Takashi Fukuda
- grid.415776.60000 0001 2037 6433Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Kojiro Shimozuma
- grid.262576.20000 0000 8863 9909Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, Kusatsu, Japan
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22
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Franco KFM, Miyamoto GC, Franco YRDS, Salvador EMES, do Nascimento BCB, Menten LA, Cabral CMN. Is Pilates more effective and cost-effective than aerobic exercise in the treatment of patients with fibromyalgia syndrome? A randomized controlled trial with economic evaluation. Eur J Pain 2023; 27:54-71. [PMID: 36097826 DOI: 10.1002/ejp.2039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/30/2022] [Accepted: 09/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to assess the effectiveness and cost-effectiveness of Pilates versus aerobic exercises in the treatment of patients with fibromyalgia syndrome from a societal perspective. METHODS This two-arm randomized controlled trial with blinded assessor and economic evaluation included 98 patients diagnosed with fibromyalgia syndrome using the American College of Rheumatology 2010 criteria, aged between 20 and 75 years, and pain intensity ≥3 points in the Pain Numerical Rating Scale. Patients were randomly allocated into the aerobic or Pilates group. Treatment was performed twice a week for 8 weeks. The primary outcome was the impact of fibromyalgia measured 8 weeks after randomization. Cost-effectiveness and cost-utility analyses were conducted for the impact of fibromyalgia and quality-adjusted life-years (QALYs), respectively, with a 12-month time horizon. RESULTS There was no difference between the groups for the impact of fibromyalgia (MD: 6.5 points; 95% CI: -1.8 to 14.9). The incremental cost-effectiveness ratio showed that 1-point increase in the impact of fibromyalgia was on average associated with a societal cost of £56 for the Pilates group compared to the aerobic group. The cost-utility analysis showed that the Pilates group had a 0.71 probability of being cost-effective at a willingness-to-pay of £30,000 per QALY gained. CONCLUSION There was no significant difference between groups for the impact of fibromyalgia. Pilates was not cost-effective compared to aerobic exercises for the impact of fibromyalgia. However, Pilates seemed to be the preferred option of treatment considering QALYs, although it depends on the willingness-to-pay threshold. SIGNIFICANCE Pilates showed to be a safe and effective alternative for the treatment of patients with fibromyalgia syndrome. Pilates presented similar results for the impact of fibromyalgia and superior results for pain relief compared to aerobic exercises, a highly recommended intervention for the treatment of fibromyalgia syndrome. Pilates was not cost-effective compared to aerobic exercises for the impact of fibromyalgia. However, Pilates seemed to be a cost-effective intervention for QALYs, depending on the decision-maker's willingness-to-pay threshold.
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Affiliation(s)
| | - Gisela Cristiane Miyamoto
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Brazil.,Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
| | | | | | | | - Laura Alves Menten
- Physical Therapy Department, Universidade Cidade de São Paulo, Sao Paulo, Brazil
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23
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Li H, Zhuang T, Wu W, Gan W, Wu C, Peng S, Huan S, Liu N. A systematic review on the cost-effectiveness of the computer-assisted orthopedic system. HEALTH CARE SCIENCE 2022; 1:173-185. [PMID: 38938554 PMCID: PMC11080830 DOI: 10.1002/hcs2.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/30/2022] [Accepted: 09/14/2022] [Indexed: 06/29/2024]
Abstract
Computer-assisted orthopedic system (CAOS) is rapidly gaining popularity in the field of precision medicine. However, the cost-effectiveness of CAOS has not been well clarified. We performed this review to summarize and assess the cost-effectiveness analyses (CEAs) with regard to CAOS. Publications on CEA in CAOS have been searched in PubMed and CEA Registry up to May 31, 2022. The Quality of Health Economic Studies (QHES) instrument was used to estimate the quality of studies. Relationships between qualities and potential factors were also examined. There were 15 eligible studies in the present review. Twelve studies evaluated CAOS joint arthroplasties and found that CAOS joint arthroplasties were cost-effective compared to manual methods. Three studies focused on spinal surgery, two of which analyzed the cost-effectiveness of CAOS for patients after spinal fusion, with conflicting results. One study demonstrated that CAOS was cost-effective in spinal pedicle screw insertion. The mean QHES score of CEAs included was 86.1. The potential factors had no significant relationship with the quality of studies. Based on available studies, our review reflected that CAOS was cost-effective in the field of joint arthroplasty. While in spinal surgery, the answer was unclear. Current CEAs represent high qualities, and more CEAs are required in the different disciplines of orthopedics where CAOS is employed.
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Affiliation(s)
- Hua Li
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Tengfeng Zhuang
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Wenrui Wu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Wenyi Gan
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Chongjie Wu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Sijun Peng
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Songwei Huan
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Ning Liu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
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24
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El Alili M, van Dongen JM, Esser JL, Heymans MW, van Tulder MW, Bosmans JE. A scoping review of statistical methods for trial-based economic evaluations: The current state of play. HEALTH ECONOMICS 2022; 31:2680-2699. [PMID: 36089775 PMCID: PMC9826466 DOI: 10.1002/hec.4603] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/21/2022] [Accepted: 08/11/2022] [Indexed: 06/06/2023]
Abstract
The statistical quality of trial-based economic evaluations is often suboptimal, while a comprehensive overview of available statistical methods is lacking. Therefore, this review summarized and critically appraised available statistical methods for trial-based economic evaluations. A literature search was performed to identify studies on statistical methods for dealing with baseline imbalances, skewed costs and/or effects, correlated costs and effects, clustered data, longitudinal data, missing data and censoring in trial-based economic evaluations. Data was extracted on the statistical methods described, their advantages, disadvantages, relative performance and recommendations of the study. Sixty-eight studies were included. Of them, 27 (40%) assessed methods for baseline imbalances, 39 (57%) assessed methods for skewed costs and/or effects, 27 (40%) assessed methods for correlated costs and effects, 18 (26%) assessed methods for clustered data, 7 (10%) assessed methods for longitudinal data, 26 (38%) assessed methods for missing data and 10 (15%) assessed methods for censoring. All identified methods were narratively described. This review provides a comprehensive overview of available statistical methods for dealing with the most common statistical complexities in trial-based economic evaluations. Herewith, it can provide valuable input for researchers when deciding which statistical methods to use in a trial-based economic evaluation.
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Affiliation(s)
- Mohamed El Alili
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Johanna M. van Dongen
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Movement Sciences Research InstituteAmsterdamthe Netherlands
| | - Jonas L. Esser
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and BiostatisticsAmsterdam UMC, Location VUmcAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Maurits W. van Tulder
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Movement Sciences Research InstituteAmsterdamthe Netherlands
- Department of Physiotherapy & Occupational TherapyAarhus University HospitalAarhusDenmark
| | - Judith E. Bosmans
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
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25
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1309-1317. [PMID: 35084632 PMCID: PMC9550741 DOI: 10.1007/s10198-021-01426-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 06/13/2023]
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc.). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
- Institute of Health Economics, 879 Winnington Ave, Ottawa, ON, K2B 5C4, Canada.
| | | | - Federico Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
- University of Buenos Aires, Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andrew H Briggs
- London School of Hygiene and Tropical Medicine, London, England, UK
| | | | - Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | | | - Josephine Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - Sophie Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Ben ÂJ, van Dongen JM, Alili ME, Heymans MW, Twisk JWR, MacNeil-Vroomen JL, de Wit M, van Dijk SEM, Oosterhuis T, Bosmans JE. The handling of missing data in trial-based economic evaluations: should data be multiply imputed prior to longitudinal linear mixed-model analyses? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022:10.1007/s10198-022-01525-y. [PMID: 36161553 DOI: 10.1007/s10198-022-01525-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION For the analysis of clinical effects, multiple imputation (MI) of missing data were shown to be unnecessary when using longitudinal linear mixed-models (LLM). It remains unclear whether this also applies to trial-based economic evaluations. Therefore, this study aimed to assess whether MI is required prior to LLM when analyzing longitudinal cost and effect data. METHODS Two-thousand complete datasets were simulated containing five time points. Incomplete datasets were generated with 10, 25, and 50% missing data in follow-up costs and effects, assuming a Missing At Random (MAR) mechanism. Six different strategies were compared using empirical bias (EB), root-mean-squared error (RMSE), and coverage rate (CR). These strategies were: LLM alone (LLM) and MI with LLM (MI-LLM), and, as reference strategies, mean imputation with LLM (M-LLM), seemingly unrelated regression alone (SUR-CCA), MI with SUR (MI-SUR), and mean imputation with SUR (M-SUR). RESULTS For costs and effects, LLM, MI-LLM, and MI-SUR performed better than M-LLM, SUR-CCA, and M-SUR, with smaller EBs and RMSEs as well as CRs closers to nominal levels. However, even though LLM, MI-LLM and MI-SUR performed equally well for effects, MI-LLM and MI-SUR were found to perform better than LLM for costs at 10 and 25% missing data. At 50% missing data, all strategies resulted in relatively high EBs and RMSEs for costs. CONCLUSION LLM should be combined with MI when analyzing trial-based economic evaluation data. MI-SUR is more efficient and can also be used, but then an average intervention effect over time cannot be estimated.
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Affiliation(s)
- Ângela Jornada Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Mohamed El Alili
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Janet L MacNeil-Vroomen
- Section of Geriatrics, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Susan E M van Dijk
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Teddy Oosterhuis
- Netherlands Society of Occupational Medicine (NVAB), Utrecht, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Nicklas L, Albiston M, Dunbar M, Gillies A, Hislop J, Moffat H, Thomson J. A systematic review of economic analyses of psychological interventions and therapies in health-related settings. BMC Health Serv Res 2022; 22:1131. [PMID: 36071425 PMCID: PMC9450839 DOI: 10.1186/s12913-022-08158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background This review aims to synthesise evidence on the economic impact of psychological interventions and therapies when applied to a broad range of physical health conditions. Methods The following bibliographic databases were searched for relevant articles: MEDLINE (Ovid), EMBASE (Ovid) and PsycINFO (Ebsco). As this review was intended to update an earlier review, the date range for the search was restricted to between January 2012 and September 2018. Reference lists from the review articles were also searched for relevant articles. Study quality was evaluated using the Scottish Intercollegiate Network Guidelines (SIGN) appraisal checklists for both economic studies and Randomised Controlled Trials (RCTs). When the economic analyses did not provide sufficient detail for quality evaluation, the original RCT papers were sought and these were also evaluated. Half of the papers were quality rated by a second author. Initial agreement was high and all disagreements were resolved by discussion. Results This yielded 1408 unique articles, reduced to 134 following screening of the title and abstract. The full texts of the remaining articles were reviewed by at least one team member and all exclusions were discussed and agreed by the team. This left 46 original research articles, alongside five systematic reviews. Fifty-seven per cent of the articles were deemed to be of high quality, with the remainder of acceptable quality. Fifteen different medical conditions were covered, with chronic pain (10 articles) and cancer (9 articles) being the two most investigated health conditions. Three quarters of the papers reviewed showed evidence for the cost-effectiveness of psychological interventions in physical health, with the clearest evidence being in the field of chronic pain and cancer. Conclusions This paper provides a comprehensive integration of the research on the cost-effectiveness of psychological therapies in physical health. Whilst the evidence for cost-effectiveness in chronic pain and cancer is encouraging, some health conditions require further study. Clearly, as the primary research is international, and was therefore conducted across varying health care systems, caution must be exercised when applying the results to counties outside of those covered. Despite this, the results are of potential relevance to service providers and funders. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08158-0.
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Affiliation(s)
- Leeanne Nicklas
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK.
| | - Mairi Albiston
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | - Martin Dunbar
- Stobhill Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Alan Gillies
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | | | - Helen Moffat
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Judy Thomson
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
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28
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations. PHARMACOECONOMICS 2022; 40:601-609. [PMID: 35015272 PMCID: PMC9130151 DOI: 10.1007/s40273-021-01112-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 05/19/2023]
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, and the increased role of stakeholder involvement, including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as healthcare, public health, education, social care, etc.). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer-reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
- Institute of Health Economics, Edmonton, AL, Canada.
| | | | - Federico Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
- University of Buenos Aires, Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Andrew H Briggs
- London School of Hygiene and Tropical Medicine, London, England
| | | | - Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | | | - Josephine Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- Ministry of Health and Welfare, National Hepatitis C Program Office, Taipei City, Taiwan
| | - Sophie Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Khairnar R, DeMora L, Sandler HM, Lee WR, Villalonga-Olives E, Mullins CD, Palumbo FB, Bruner DW, Shaya FT, Bentzen SM, Shah AB, Malone S, Michalski JM, Dayes IS, Seaward SA, Albert M, Currey AD, Pisansky TM, Chen Y, Horwitz EM, DeNittis AS, Feng F, Mishra MV. Methodological Comparison of Mapping the Expanded Prostate Cancer Index Composite to EuroQoL-5D-3L Using Cross-Sectional and Longitudinal Data: Secondary Analysis of NRG/RTOG 0415. JCO Clin Cancer Inform 2022; 6:e2100188. [PMID: 35776901 DOI: 10.1200/cci.21.00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare the predictive ability of mapping algorithms derived using cross-sectional and longitudinal data. METHODS This methodological assessment used data from a randomized controlled noninferiority trial of patients with low-risk prostate cancer, conducted by NRG Oncology (ClinicalTrials.gov identifier: NCT00331773), which examined the efficacy of conventional schedule versus hypofractionated radiation therapy (three-dimensional conformal external beam radiation therapy/IMRT). Health-related quality-of-life data were collected using the Expanded Prostate Cancer Index Composite (EPIC), and health utilities were obtained using EuroQOL-5D-3L (EQ-5D) at baseline and 6, 12, 24, and 60 months postintervention. Mapping algorithms were estimated using ordinary least squares regression models through five-fold cross-validation in baseline cross-sectional data and combined longitudinal data from all assessment periods; random effects specifications were also estimated in longitudinal data. Predictive performance was compared using root mean square error. Longitudinal predictive ability of models obtained using baseline data was examined using mean absolute differences in the reported and predicted utilities. RESULTS A total of 267 (and 199) patients in the estimation sample had complete EQ-5D and EPIC domain (and subdomain) data at baseline and at all subsequent assessments. Ordinary least squares models using combined data showed better predictive ability (lowest root mean square error) in the validation phase for algorithms with EPIC domain/subdomain data alone, whereas models using baseline data outperformed other specifications in the validation phase when patient covariates were also modeled. The mean absolute differences were lower for models using EPIC subdomain data compared with EPIC domain data and generally decreased as the time of assessment increased. CONCLUSION Overall, mapping algorithms obtained using baseline cross-sectional data showed the best predictive performance. Furthermore, these models demonstrated satisfactory longitudinal predictive ability.
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Affiliation(s)
- Rahul Khairnar
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Lyudmila DeMora
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - W Robert Lee
- Department of Radiation Oncology, Duke University, Durham, NC
| | - Ester Villalonga-Olives
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Francis B Palumbo
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD
| | | | - Fadia T Shaya
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Soren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Amit B Shah
- WellSpan Health-York Cancer Center, York, PA
| | - Shawn Malone
- Ottawa Hospital and Cancer Center, Ottawa, Ontario, Canada
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University, St Louis, MO
| | - Ian S Dayes
- Juravinski Cancer Center at Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | - Adam D Currey
- Zablocki VAMC and the Medical College of Wisconsin, Milwaukee, WI
| | - Thomas M Pisansky
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN
| | - Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester, Rochester, NY
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Felix Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Mark V Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
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How to appraise the literature: basic principles for the busy clinician - part 1: randomised controlled trials. Br Dent J 2022; 232:475-481. [PMID: 35396432 DOI: 10.1038/s41415-022-4096-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/25/2021] [Indexed: 11/08/2022]
Abstract
Critical appraisal is the process of carefully, judiciously and systematically examining research to adjudicate its trustworthiness and its value and relevance in clinical practice. The first part of this two-part series will discuss the principles of critically appraising randomised controlled trials. The second part will discuss the principles of critically appraising systematic reviews and meta-analyses.Evidence-based dentistry (EBD) is the integration of the dentist's clinical expertise, the patient's needs and preferences and the most current, clinically relevant evidence. Critical appraisal of the literature is an invaluable and indispensable skill that dentists should possess to help them deliver EBD.This article seeks to act as a refresher and guide for generalists, specialists and the wider readership, so that they can efficiently and confidently appraise research - specifically, randomised controlled trials - that may be pertinent to their daily clinical practice.
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31
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:213-221. [PMID: 35015207 PMCID: PMC8847248 DOI: 10.1007/s40258-021-00704-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
- Institute of Health Economics, Edmonton, AL, Canada.
| | | | - Federico Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
- University of Buenos Aires, Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andrew H Briggs
- London School of Hygiene and Tropical Medicine, London, England
| | | | - Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | | | - Josephine Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - Sophie Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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32
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Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations. Clin Ther 2022; 44:158-168. [DOI: 10.1016/j.clinthera.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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33
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. J Manag Care Spec Pharm 2022; 28:146-155. [PMID: 35098747 PMCID: PMC10372979 DOI: 10.18553/jmcp.2022.28.2.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- adjunct professor, senior associate, School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada. Institute of Health Economics, Alberta, Canada
| | - Michael Drummond
- Michael Drummond, professor, Centre for Health Economics, University of York, York, UK
| | - Federico Augustovski
- director, professor of public health, principal researcher, Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- full professor of health economics & health preferences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andrew H Briggs
- professor of health economics, London School of Hygiene and Tropical Medicine, London, England, UK
| | - Chris Carswell
- senior editor, Adis Journals, Springer Nature, Auckland, New Zealand
| | - Lisa Caulley
- assistant professor, associate scientist, doctoral candidate, Department of Otolaryngology – Head & Neck Surgery, University of Ottawa, Ontario, Canada. Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada. Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- professor, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Dan Greenberg
- professor, Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva, Israel
| | - Elizabeth Loder
- professor, head of research, Harvard Medical School, Boston, MA, USA; The BMJ, London, UK
| | - Josephine Mauskopf
- vice president, RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- professor and chair, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- professor of health economics, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - Sophie Staniszewska
- professor of health research, on behalf of CHEERS 2022 ISPOR Good Research Practices Task Force. Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMC Health Serv Res 2022; 22:114. [PMID: 35081957 PMCID: PMC8793223 DOI: 10.1186/s12913-021-07460-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada.
- Institute of Health Economics, Alberta, Canada.
| | | | - Federico Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
- University of Buenos Aires, Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andrew H Briggs
- London School of Hygiene and Tropical Medicine, London, England, UK
| | | | - Lisa Caulley
- Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada
- Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | | | - Josephine Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - Sophie Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMC Public Health 2022; 22:179. [PMID: 35081920 PMCID: PMC8793177 DOI: 10.1186/s12889-021-12491-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada.
- Institute of Health Economics, Alberta, Canada.
| | | | - Federico Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
- University of Buenos Aires, Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andrew H Briggs
- London School of Hygiene and Tropical Medicine, London, England, UK
| | | | - Lisa Caulley
- Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada
- Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | | | - Josephine Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - Sophie Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. MDM Policy Pract 2022; 7:23814683211061097. [PMID: 35036563 PMCID: PMC8755935 DOI: 10.1177/23814683211061097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Michael Drummond
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Federico Augustovski
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Esther de Bekker-Grob
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Andrew H Briggs
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Chris Carswell
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Lisa Caulley
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Nathorn Chaiyakunapruk
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Dan Greenberg
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Elizabeth Loder
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Josephine Mauskopf
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - C Daniel Mullins
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Stavros Petrou
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Raoh-Fang Pwu
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Sophie Staniszewska
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.,Centre for Health Economics, University of York, York, UK.,Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,London School of Hygiene and Tropical Medicine, London, England, UK.,Adis Journals, Springer Nature, Auckland, New Zealand.,Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK.,RTI Health Solutions, RTI International, Research Triangle Park, NC, USA.,School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA; Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan.,Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMC Med 2022; 20:23. [PMID: 35022047 PMCID: PMC8753858 DOI: 10.1186/s12916-021-02204-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada.
- Institute of Health Economics, Alberta, Canada.
| | | | - Federico Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
- University of Buenos Aires, Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andrew H Briggs
- London School of Hygiene and Tropical Medicine, London, England, UK
| | | | - Lisa Caulley
- Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada
- Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | | | - Josephine Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - Sophie Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. J Manag Care Spec Pharm 2022:1-10. [PMID: 35016547 DOI: 10.18553/jmcp.2022.cheers] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- adjunct professor, senior associate, School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada. Institute of Health Economics, Alberta, Canada
| | - Michael Drummond
- professor, Centre for Health Economics, University of York, York, UK
| | - Federico Augustovski
- director, professor of public health, principal researcher, Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- full professor of health economics & health preferences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andrew H Briggs
- professor of health economics, London School of Hygiene and Tropical Medicine, London, England, UK
| | - Chris Carswell
- senior editor, Adis Journals, Springer Nature, Auckland, New Zealand
| | - Lisa Caulley
- assistant professor, associate scientist, doctoral candidate, Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada. Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada. Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- professor, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Dan Greenberg
- professor, Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Elizabeth Loder
- professor, head of research, Harvard Medical School, Boston, MA, USA; The BMJ, London, UK
| | - Josephine Mauskopf
- Josephine Mauskopf, vice president, RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- professor and chair, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- professor of health economics, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - Sophie Staniszewska
- professor of health research, on behalf of CHEERS 2022 ISPOR Good Research Practices Task Force. Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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39
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMJ 2022; 376:e067975. [PMID: 35017145 PMCID: PMC8749494 DOI: 10.1136/bmj-2021-067975] [Citation(s) in RCA: 143] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada; Institute of Health Economics, Alberta, Canada
| | | | - Federico Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires; University of Buenos Aires, Buenos Aires; CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andrew H Briggs
- London School of Hygiene and Tropical Medicine, London, England, UK
| | | | - Lisa Caulley
- Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada; Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada; Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Elizabeth Loder
- Harvard Medical School, Boston, MA, USA; The BMJ, London, UK
| | - Josephine Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - Sophie Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Int J Technol Assess Health Care 2022; 38:e13. [PMID: 35007499 DOI: 10.1017/s0266462321001732] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc.). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer-reviewed journals, as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations. J Med Econ 2022; 25:1-7. [PMID: 35012427 DOI: 10.1080/13696998.2021.2014721] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- Institute of Health Economics, Alberta, Canada
| | | | - Federico Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires; University of Buenos Aires, Buenos Aires; CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andrew H Briggs
- London School of Hygiene and Tropical Medicine, London, England, UK
| | | | - Lisa Caulley
- Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada; Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | | | - Josephine Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - Sophie Staniszewska
- Warwick Research in Nursing, University of Warwick Medical School, Warwick, UK
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:3-9. [PMID: 35031096 DOI: 10.1016/j.jval.2021.11.1351] [Citation(s) in RCA: 274] [Impact Index Per Article: 137.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 05/23/2023]
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada, Institute of Health Economics, Alberta, Canada.
| | | | - Federico Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, University of Buenos Aires, Buenos Aires, CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andrew H Briggs
- London School of Hygiene and Tropical Medicine, London, England, UK
| | | | - Lisa Caulley
- Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada, Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada, Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Elizabeth Loder
- Harvard Medical School, Boston, MA, USA, The BMJ, London, UK
| | - Josephine Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- Stavros Petros., Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - Sophie Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Daniel Mullins C, Petrou S, Pwu RF, Staniszewska S. TEMPORARY REMOVAL: Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. HEALTH POLICY OPEN 2022. [DOI: 10.1016/j.hpopen.2021.100063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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44
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Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Explanation and Elaboration: A Report of the ISPOR CHEERS II Good Practices Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:10-31. [PMID: 35031088 DOI: 10.1016/j.jval.2021.10.008] [Citation(s) in RCA: 260] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 05/22/2023]
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces the previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, and the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as healthcare, public health, education, and social care). This Explanation and Elaboration Report presents the new CHEERS 2022 28-item checklist with recommendations and explanation and examples for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer-reviewed journals and the peer reviewers and editors assessing them for publication. Nevertheless, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, given that there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- Don Husereau
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, Ontario, Canada and Institute of Health Economics, Edmonton, Alberta, Canada (Husereau).
| | | | - Federico Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS- CONICET), Buenos Aires; University of Buenos Aires, Buenos Aires; CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andrew H Briggs
- London School of Hygiene and Tropical Medicine, London, England, UK
| | | | - Lisa Caulley
- Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ontario, Canada; Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ontario, Canada; Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Elizabeth Loder
- Harvard Medical School, Boston, MA, USA; The BMJ, London, UK
| | - Josephine Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C Daniel Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - Sophie Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Erku D, Schneider J, Scuffham P. A framework for economic evaluation of therapeutic drug monitoring-guided dosing in oncology. Pharmacol Res Perspect 2021; 9:e00862. [PMID: 34546005 PMCID: PMC8453491 DOI: 10.1002/prp2.862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
The standard approach for dose individualization of chemotherapy in the oncology setting has long been based on body surface area (BSA) as a measure of body size. However, for many anticancer drugs, administration of dosages based on BSA may result in some patients receiving supratherapeutic or subtherapeutic concentrations due to substantial interindividual pharmacokinetic variability. Therapeutic drug monitoring (TDM)-guided dosing aims to ensure that the patient's serum drug concentration is in a target range which has been shown to produce optimal clinical outcomes. The management of several malignancies is now moving away from using traditional intravenous chemotherapy to longer-term treatment with targeted molecular therapies. These targeted anticancer drugs are currently dosed based on a fixed dose for all patients. The pharmacokinetic characteristics of most of these drugs (e.g., tyrosine-kinase inhibitors) support implementation of individualized dosing via TDM. However, prior to adopting TDM-guided dosing in oncology settings, the economic efficiency and value for money of introducing TDM interventions should be critically and systematically examined along with the impacts on patient care and outcomes. Yet, current evidence in this area is limited, and more generally, there is lack of methodological guidance on how to identify, estimate and value clinical and cost information necessary to conduct economic evaluations of TDM interventions. In this paper, we propose a coherent framework for conducting economic evaluation of TDM interventions in oncology settings and discuss some practical challenges of conducting economic evaluations of TDM.
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Affiliation(s)
- Daniel Erku
- Centre for Applied Health EconomicsGriffith UniversityNathanQueenslandAustralia
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Jennifer Schneider
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Paul Scuffham
- Centre for Applied Health EconomicsGriffith UniversityNathanQueenslandAustralia
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
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Cabral CMN, Miyamoto GC, Franco KFM, Bosmans JE. Economic evaluations of educational, physical, and psychological treatments for fibromyalgia: a systematic review with meta-analysis. Pain 2021; 162:2331-2345. [PMID: 33605655 DOI: 10.1097/j.pain.0000000000002233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/02/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Nonpharmacological interventions are recommended for the treatment of fibromyalgia, but there is a lack of knowledge about the cost-effectiveness of these interventions. The aim of this study was to systematically review economic evaluations of educational, physical, and psychological interventions for the treatment of fibromyalgia. The search was performed in PUBMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, PsycINFO, EconLit, National Health Service Economic Evaluation Database, and Health Technology Assessment. Economic evaluations of educational, physical, and psychological interventions for adult patients with fibromyalgia were included. Primary outcomes were healthcare and societal costs, and quality-adjusted life-years, and secondary outcomes were any disease-specific clinical outcome. Costs and effects were pooled in a meta-analysis, when possible. Eleven studies were included, of which 7 compared a psychological intervention with another intervention or usual care/control. Over a 6-month time horizon, healthcare and societal costs of the psychological intervention were significantly lower than usual care (mean difference: $-2087, 95% confidence interval [CI]: -3061 to -1112; mean difference: $-2411, 95% CI: -3582 to -1240, respectively), and healthcare costs were significantly lower for the psychological intervention compared with a pharmacological intervention (mean difference: $-1443, 95% CI: -2165 to -721). Over a 12-month time horizon, healthcare costs for the psychological intervention were significantly lower than for usual care (mean difference: $-538, 95% CI: -917 to -158). Incremental cost-effectiveness ratios for quality-adjusted life-years and impact of fibromyalgia showed that the psychological intervention was cost-effective compared with other interventions and control conditions. There is a need of more economic evaluations conducted alongside randomized controlled trials with interventions recommended for the treatment of fibromyalgia, such as physical exercise.
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Affiliation(s)
- Cristina Maria Nunes Cabral
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands
| | - Gisela Cristiane Miyamoto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands
| | | | - Judith Ekkina Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands
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47
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Heggie R, Boyd K, Wu O. How has implementation been incorporated in health technology assessments in the United Kingdom? A systematic rapid review. Health Res Policy Syst 2021; 19:118. [PMID: 34407834 PMCID: PMC8371806 DOI: 10.1186/s12961-021-00766-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Health interventions in a clinical setting may be complex. This is particularly true of clinical interventions which require systems reorganization or behavioural change, and/or when implementation involves additional challenges not captured within a clinical trial setting. Medical Research Council guidance on complex interventions highlights the need to consider economic evaluation alongside implementation. However, the extent to which this guidance has been adhered to, and how, is unclear. The failure to incorporate implementation within the evaluation of an intervention may hinder the translation of research findings into routine practice. This will have consequences for patient care. This study examined the methods used to address implementation within health research conducted through funding from the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme. METHODS We conducted a rapid review using a systematic approach. We included all NIHR HTA monographs which contained the word "implementation" within the title or abstract published between 2014 and 2020. We assessed the studies according to existing recommendations for specifying and reporting implementation approaches in research. Additional themes which were not included in the recommendation, but were of particular relevance to our research question, were also identified and summarized in a narrative synthesis. RESULTS The extent to which implementation was formally incorporated, and defined, varied among studies. Methods for examining implementation ranged from single stakeholder engagement events to the more comprehensive process evaluation. There was no obvious pattern as to whether approaches to implementation had evolved over recent years. Approximately 50% (22/42) of studies included an economic evaluation. Of these, two studies included the use of qualitative data obtained within the study to quantitatively inform aspects relating to implementation and economic evaluation in their study. DISCUSSION A variety of approaches were identified for incorporating implementation within an HTA. However, they did not go far enough in terms of incorporating implementation into the actual design and evaluation. To ensure the implementation of clinically effective and cost-effective interventions, we propose that further guidance on how to incorporate implementation within complex interventions is required. Incorporating implementation into economic evaluation provides a step in this direction.
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Affiliation(s)
- Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
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48
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O'Reilly DJ, Blackhouse G, Bowen JM, Brozic A, Agema P, Punthakee Z, McInnes N, Gerstein HC, Sherifali D. Economic Analysis of a Diabetes Health Coaching Intervention for Adults Living With Type 2 Diabetes: A Single-Centre Evaluation From a Community-Based Randomized Controlled Trial. Can J Diabetes 2021; 46:165-170. [PMID: 35115250 DOI: 10.1016/j.jcjd.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/28/2021] [Accepted: 08/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A recent randomized controlled trial demonstrated that a community-based, telephone-delivered diabetes health coaching intervention was effective for improving diabetes management. Our aim in this study was to determine whether this intervention is also cost-effective. METHODS An economic evaluation, in the form of a cost-utility analysis (CUA), was used to assess the cost-effectiveness of the coaching intervention from a public payer's perspective. All direct medical costs, as well as intervention implementation, were included. The outcome measure for the CUA was quality-adjusted life-year (QALY). Uncertainty of cost-effectiveness results was estimated using nonparametric bootstraps of patient-level costs and QALYs in the coaching and control arms. A cost-effectiveness acceptability curve was used to express this uncertainty as the probability that diabetes health coaching is cost-effective across a range of values of willingness-to-pay thresholds for a QALY. RESULTS The results show that subjects in the coaching arm incurred higher overall costs (in Canadian dollars) than subjects in the control arm ($1,581 vs $1,086, respectively) and incurred 0.02 more QALYs. The incremental cost-effectiveness ratio of the diabetes health coaching intervention compared with usual care was found to be $35,129 per QALY, with probabilities of 67% and 82% that diabetes health coaching would be cost-effective at a willingness-to-pay threshold of $50,000 per QALY and $100,000 per QALY, respectively. CONCLUSION A community-based, telephone-delivered diabetes health coaching intervention is cost-effective.
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Affiliation(s)
- Daria J O'Reilly
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Pharmacy Consulting, Health Benefits Management, TELUS Health, Toronto, Ontario, Canada; Programs for Assessment of Technology in Health, Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Gord Blackhouse
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health, Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - James M Bowen
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University Health Network Research Institute, Toronto, Ontario, Canada
| | - Anka Brozic
- Kitchener Downtown Community Health Centre, Kitchener, Ontario, Canada
| | - Pieter Agema
- Langs Community Health Centre, Cambridge, Ontario, Canada
| | - Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Natalia McInnes
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Hertzel C Gerstein
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Diana Sherifali
- Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario, Canada; School of Nursing, Faculty of Health Sciences. McMaster University, Hamilton, Ontario, Canada.
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49
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Hopewell S, Keene DJ, Heine P, Marian IR, Dritsaki M, Cureton L, Dutton SJ, Dakin H, Carr A, Hamilton W, Hansen Z, Jaggi A, Littlewood C, Barker K, Gray A, Lamb SE. Progressive exercise compared with best-practice advice, with or without corticosteroid injection, for rotator cuff disorders: the GRASP factorial RCT. Health Technol Assess 2021; 25:1-158. [PMID: 34382931 PMCID: PMC9421560 DOI: 10.3310/hta25480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rotator cuff-related shoulder pain is very common, but there is uncertainty regarding which modes of exercise delivery are optimal and the long-term benefits of corticosteroid injections. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of progressive exercise compared with best-practice physiotherapy advice, with or without corticosteroid injection, in adults with a rotator cuff disorder. DESIGN This was a pragmatic multicentre superiority randomised controlled trial (with a 2 × 2 factorial design). SETTING Twenty NHS primary care-based musculoskeletal and related physiotherapy services. PARTICIPANTS Adults aged ≥ 18 years with a new episode of rotator cuff-related shoulder pain in the previous 6 months. INTERVENTIONS A total of 708 participants were randomised (March 2017-May 2019) by a centralised computer-generated 1 : 1 : 1 : 1 allocation ratio to one of four interventions: (1) progressive exercise (n = 174) (six or fewer physiotherapy sessions), (2) best-practice advice (n = 174) (one physiotherapy session), (3) corticosteroid injection then progressive exercise (n = 182) (six or fewer physiotherapy sessions) or (4) corticosteroid injection then best-practice advice (n = 178) (one physiotherapy session). MAIN OUTCOME MEASURES The primary outcome was Shoulder Pain and Disability Index (SPADI) score over 12 months. Secondary outcomes included SPADI subdomains, the EuroQol 5 Dimensions, five-level version, sleep disturbance, fear avoidance, pain self-efficacy, return to activity, Global Impression of Treatment and health resource use. Outcomes were collected by postal questionnaires at 8 weeks and at 6 and 12 months. A within-trial economic evaluation was also conducted. The primary analysis was intention to treat. RESULTS Participants had a mean age of 55.5 (standard deviation 13.1) years and 49.3% were female. The mean baseline SPADI score was 54.1 (standard deviation 18.5). Follow-up rates were 91% at 8 weeks and 87% at 6 and 12 months. There was an overall improvement in SPADI score from baseline in each group over time. Over 12 months, there was no evidence of a difference in the SPADI scores between the progressive exercise intervention and the best-practice advice intervention in shoulder pain and function (adjusted mean difference between groups over 12 months -0.66, 99% confidence interval -4.52 to 3.20). There was also no difference in SPADI scores between the progressive exercise intervention and best-practice advice intervention when analysed at the 8-week and 6- and 12-month time points. Injection resulted in improvement in shoulder pain and function at 8 weeks compared with no injection (adjusted mean difference -5.64, 99% confidence interval -9.93 to -1.35), but not when analysed over 12 months (adjusted mean difference -1.11, 99% confidence interval -4.47 to 2.26), or at 6 and 12 months. There were no serious adverse events. In the base-case analysis, adding injection to best-practice advice gained 0.021 quality-adjusted life-years (p = 0.184) and increased the cost by £10 per participant (p = 0.747). Progressive exercise alone was £52 (p = 0.247) more expensive per participant than best-practice advice, and gained 0.019 QALYs (p = 0.220). At a ceiling ratio of £20,000 per quality-adjusted life-year, injection plus best-practice advice had a 54.93% probability of being the most cost-effective treatment. LIMITATIONS Participants and physiotherapists were not blinded to group allocation. Twelve-month follow-up may be insufficient for identifying all safety concerns. CONCLUSIONS Progressive exercise was not superior to a best-practice advice session with a physiotherapist. Subacromial corticosteroid injection improved shoulder pain and function, but provided only modest short-term benefit. Best-practice advice in combination with corticosteroid injection was expected to be most cost-effective, although there was substantial uncertainty. FUTURE WORK Longer-term follow-up, including any serious adverse effects of corticosteroid injection. TRIAL REGISTRATION Current Controlled Trials ISRCTN16539266 and EudraCT 2016-002991-28. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 48. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sally Hopewell
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Peter Heine
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ioana R Marian
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Melina Dritsaki
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lucy Cureton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Susan J Dutton
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Helen Dakin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Willie Hamilton
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Zara Hansen
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Anju Jaggi
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | - Karen Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alastair Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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50
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Ray S, Neogi SB, Singh R, Devasenapathy N, Zodpey S. Is IV iron sucrose a cost-effective option for treatment of severe anaemia in pregnancy as compared with oral iron? Health Policy Plan 2021; 35:1339-1346. [PMID: 33230561 DOI: 10.1093/heapol/czaa110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 11/12/2022] Open
Abstract
Anaemia in pregnancy is a public health concern because it is strongly associated with maternal and perinatal morbidity and mortality. An open label randomized controlled trial (RCT) was conducted in India across four government medical colleges, comparing intravenous (IV) iron sucrose and oral iron for the treatment of anaemia in pregnancy. This RCT failed to demonstrate superiority of IV iron sucrose compared with oral iron therapy in reducing adverse clinical (maternal and foetal/neonatal) outcomes in moderate-to-severe anaemia in pregnancy. However, IV iron sucrose seemed to reduce the need for blood transfusion among women with severe anaemia. The study objective was to conduct a cost-effectiveness analysis of IV iron sucrose over oral therapy for treatment of severe anaemia in pregnancy, alongside the RCT, to inform policy. The outcome of interest in our study was a 'safe delivery' defined by the absence of composite maternal and foetal/neonatal adverse clinical outcomes. Incremental cost-effectiveness ratio (ICER) was calculated from a limited societal perspective. IV iron sucrose was found to be more costly but more effective than the oral therapy for treatment of severe anaemia. The ICER was calculated at INR 31 951 (USD 445.2) per safe delivery. We considered a threshold of half the gross national income for decision-making. Considering this threshold of India (INR 57 230, USD 797.4), IV iron-sucrose remained cost-effective in 67% of the iterations in the model. At the current ICER, for every 32 severely anaemic pregnant woman treated with IV iron sucrose one additional pregnant woman will have a safe delivery. Such analyses can complement the national strategy to support evidence-based action.
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Affiliation(s)
- Shomik Ray
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Plot Number 47, Sector 44, Gurgaon 122002, India
| | - Sutapa B Neogi
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Plot Number 47, Sector 44, Gurgaon 122002, India
| | - Ranjana Singh
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Plot Number 47, Sector 44, Gurgaon 122002, India
| | - Niveditha Devasenapathy
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Plot Number 47, Sector 44, Gurgaon 122002, India
| | - Sanjay Zodpey
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Plot Number 47, Sector 44, Gurgaon 122002, India
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