Costs and economic evaluation

Authors

David Kaunelis
Julie Glanville


Acknowledgements


We are grateful for the assistance of Eleanor Kotas on this chapter in 2019-2020.

Last updated: 2 Dec. 2022

What's new in this update

Information on the value of searches for utilities for NICE HTAs has been added along with a reference to the ISPOR presentations database whose interface has recently been evaluated.


Introduction


This domain focuses on the importance of obtaining information about costs and outcomes as well as efficacy and effectiveness when evaluating new technologies. Economic evaluation is an important part of health technology assessment because it assists with priority-setting between different health technologies. An economic evaluation identifies, measures, values and compares the costs and outcomes of a technology with its relevant comparator.


This domain overlaps with the effectiveness domain and the organizational domain (1).


There is various guidance on conducting searching as part of systematic reviews of economic evaluations and utilities (2,3,4).


Sources to search


There are some databases which identify and collect economic evaluations and health economics studies (5,6,7,8,9,10) to promote efficient retrieval. These databases are built largely from MEDLINE and Embase, but offer a variety of value added information such as critical appraisals, results, categorisations and indexing. These databases can save time in identifying economic evaluations, but may not be comprehensive because of publication lags or geographical focus (e.g. the Cost-Effectiveness Analysis (CEA) registry). NHS EED ceased updating at the end of 2014 and is available only as a closed database. HEED is no longer available. This means that sensitive searches should also include searches of general medical databases such as MEDLINE and Embase (5,6,9,10,11,12,13). Searching Science Citation Index and conference abstracts (via websites as well as Embase) may also increase retrieval (10,13). Pitt et al. conducted a bibliometric analysis of full economic evaluations of health interventions published in 2012-14, comparing, among other things, the sensitivity and specificity of searches in 14 databases (15). This study confirms that Econlit is not a high yield resource for economic evaluations and suggests that Scopus may be a useful resource to search, which may merit investigation.


Searching non-database sources is likely to identify further studies outside of commercial journal publications (11).


The majority of recent reviews of economic evaluations have not followed published searching approaches in detail and are also currently poorly reported (16). Reviews should report the searches explicitly and search a range of resources (2,10,16). The following information sources should be considered when searching for economic evaluations and utility studies:

  • Specialist economic databases for identifying economic evaluations and utility studies (CEA Registry is a live database; Paediatric Economic Database Evaluation (PEDE) is a database of pediatric economic evaluations; NHS EED closed to new records at the end of 2014 (17,18,19)

  • Technology assessment databases (the Health Technology Assessment (HTA) database) (9,14)

  • General medical literature databases (MEDLINE, Embase, CENTRAL) (2,17)

  • Websites of HTA agencies such as NICE, CADTH, HAS and PBAC (2)

  • Grey literature (2,5,6) including but not limited to, the ISPOR Presentations database whose interface has been recently evaluated (20)

  • HTAi conferences

  • ISOQoL

  • the RePEC economic working papers collection

  • Collections of utility studies including ScHARRHUD and instrument websites (2,19), as well as utility mapping collections (such as the HERC Database of Mapping Studies which contains studies which map measures to EQ-5D) (21,22).


Identifying information to populate economic models may involve searching sources ranging from statistical resources to bibliographic databases (5,6,23,24,25,26,27). Guidance on suggested minimum searching levels for model parameters is available, although the author notes that much of the guidance has not been empirically tested (27). Additional suggestions for identifying utility studies include standard approaches such as checking the reference lists of eligible studies, consulting experts, carrying out citation searches and named author searching (3) and identifying completed HTA reports (28). One study has examined the use of routine data (typically obtained for health insurance funds or other reimbursement data sources rather than bibliographic databases) in economic evaluations and highlighted that these data may increasingly need to be included in economic evaluations (29).



Designing search strategies


Principles of systematic review methodology should be followed for the design of search strategies to identify economic evaluations. The recent CHEERS 2022 statement on reporting economic evaluations recommends that authors should add "economic evaluation" to article titles to aid recall and specify the type of evaluation, but despite these recommendations search filters are still currently required in the major bibliographic databases (30).


The development of sensitive subject searches within the specific economic evaluation databases is recommended to capture the population and the intervention of interest (5,6,31). An overview of methods for systematic reviews of health economic interventions suggests that a systematic search should use relevant elements of PICO combined with an economic search filter (19). Shemilt is more cautious still, suggesting that only intervention search terms may be required and focus can be achieved by adding the population concept (17). However, there is no requirement to add an economic evaluation search filter to searches within economic evaluation databases because they are pre-filtered (3,8).


Search filters for economic studies can be considered (in combination with concepts capturing the population and/or intervention) in general bibliographic databases such as MEDLINE or Embase (19). Published search filters, which can be identified from the InterTASC Information Specialists' Sub-Group (ISSG) Search Filter Resource, tend to have high sensitivity but poor precision (32,33,34). A filter validation study conducted in 2018 highlights filters with between 89.9% (2.9% precision) and 70.2% sensitivity (14.1% precision) (35). CADTH offers a more precision maximizing search filter for rapid reviews (36). Search strategies to identify cost-effectiveness information may need to be adapted from those developed for searching for effectiveness studies (37). Searching for particular economic methods may require the use of several techniques (38).


Searches to inform specific parameters of decision models may not be required to be as extensive and systematic as those to identify economic evaluations, as decision models are developed in an organic way, some parameters do not require the identification of comprehensive evidence and also it may not be feasible to conduct extensive searches for all parameters of a model (5,24,27).


Health state utility values (HSUVs) are important parameters in decision models. Recent research has indicated that for NICE HTA submissions, literature reviews for utilities are typically undertaken (28). Searching for utilities requires specific techniques (3,23,38) and the careful use of search filters can also be considered (3,). There are few subject headings dedicated to utilities within MeSH and EMTREE, and although general subject headings such as ‘Quality of life’ will yield relevant studies, they are likely to demonstrate poor precision (3). Free text terms should be included in searches and three types may be helpful to include: general terms (such as QALY), instrument specific terms (such as EQ-5D) and terms describing methods of utility elicitation such as standard gamble (3). Search filters make use of a selection of these terms which have been shown to perform well in practice (3,38,39). Arber et al. have published three validated filters for retrieving HSUVs (sensitivity maximizing; a balance of sensitivity and precision; and precision maximizing) (39). One study recommends the use of iterative searching for utilities, following an initial scoping search, and lists factors to consider when defining the search criteria (38).


Searching for cost of illness/burden of illness can make use of population search terms (perhaps taken from an accompanying effects review) (17).

Reference list

(1) EUnetHTA Joint Action 2 Work Package 8. HTA Core Model version® 2.0; 2013 (pdf). [Publication appraisal]

(2) Thielen FW, Van Mastrigt G, Burgers LT, Bramer WM, Majoie H, Evers S, et al. How to prepare a systematic review of economic evaluations for clinical practice guidelines: database selection and search strategy development (part 2/3). Expert Rev Pharmacoecon Outcomes Res. 2016; 1–17 [Publication appraisal]

(3) Ara R, Brazier J, Peasgood T, Paisley S. The identification, review and synthesis of health state utility values from the literature. Pharmacoeconomics. 2017;35:43–55. [Publication appraisal]

(4) Mandrik OL, Severens JLH, Bardach A, Ghabri S, Hamel C, Mathes T, et al. Critical Appraisal of Systematic Reviews With Costs and Cost-Effectiveness Outcomes: An ISPOR Good Practices Task Force Report. Value Health. 2021;24(4):463-472.

(5) Glanville J, Paisley S. Searching for evidence on resource use, costs, effects and cost-effectiveness. In: Shemilt I et al (eds). Evidence based economics. Oxford:Wiley-Blackwell; 2010. [Publication appraisal]

(6) Glanville J, Paisley S. Identifying economic evaluations for health technology assessment. Int J Technol Assess Health Care 2010;26(4):436-440. [Publication appraisal]

(7) Alton V, Eckerlund I, Norlund A. Health economic evaluations: how to find them. Int J Technol Assess Health Care 2006;22(4):512-517. [Publication appraisal]

(8) Nixon J, Duffy S, Armstrong N, Craig D, Glanville J, Christie J, Drummond M, Kleijnen J. The usefulness of the NHS Economic Evaluation Database to researchers undertaking technology assessment reviews. Int J Technol Assess Health Care 2004;20(3):249-257. [Publication appraisal]

(9) Luhnen M, Prediger B, Neugebauer EAM, Mathes T. Systematic reviews of economic evaluations in health technology assessment: a review of characteristics and applied methods. Int J Technol Assess Health Care. 2018 Oct;34(6):537–546. [Publication appraisal]

(10) Luhnen M, Prediger B, Neugebauer EA, Mathes T. Systematic reviews of health economic evaluations: A structured analysis of characteristics and methods applied. Res Syn Methods. 2019;10:2:195-206. [Publication appraisal]

(11) Royle P, Waugh N. Literature searching for clinical and cost-effectiveness studies used in health technology assessment reports carried out for the National Institute for Clinical Excellence appraisal system. Health Technol Assess 2003;7(34). [Publication appraisal]

(12) Waffenschmidt S, Hausner E, Engel L, Volz F, Kaiser T. Benefit of searching different databases to identify health economic evaluations in German HTA-reports. Abstract presented at: Health Technology Assessment International (HTAi) 7th Annual Meeting; 2010 June 6-9; Dublin, Ireland. Abstract T4-29. [Publication appraisal]

(13) Coyle KB, Trochlil K, Iversen P. MEDLINE and EMBASE for health economic literature reviews [abstract]. Value Health 2012;15(4):A162. [Publication appraisal]

(14) Arber M, Glanville J, Isojärvi J, Baragula E, Edwards M, Shaw A, Wood H. Which databases should be used to identify studies for systematic reviews of economic evaluations? Int J Technol Assess Health Care. 2018 Jan;34(6):547-554. [Publication appraisal]

(15) Pitt C, Goodman C, Hanson K. Economic evaluation in global perspective: a bibliometric analysis of the recent literature. Health Econ. 2016 Feb;25 Suppl 1:9-28. [Publication appraisal]

(16) Wood H, Arber M, Glanville JM. Systematic reviews of economic evaluations: How extensive are their searches? Int J Technol Assess Health Care. 2017; 27:1-7. [Publication appraisal]

(17) Shemilt I, Mugford M, Vale L, Craig D. Searching NHS EED and HEED to inform development of economic commentary for Cochrane intervention reviews. Oxford: Cochrane Collaboration; 2011. [Publication appraisal]

(18) Sullivan S M, Tsiplova K, Ungar W J. A scoping review of pediatric economic evaluation 1980-2014: do trends over time reflect changing priorities in evaluation methods and childhood disease?, Expert Rev Pharmacoecon Outcomes Res. 2016;16(5): 599-607. [Publication appraisal]

(19) Mathes T, Walgenbach M, Antoine SL, Pieper D, Eikermann M. Methods for systematic reviews of health economic evaluations: a systematic review, comparison, and synthesis of method literature. Med Decis Making. 2014;34(7):826-840. [Publication appraisal]

(20) Cooper C, Brown A, Court R, Schauberger U. A Technical Review of the ISPOR Presentations Database Identified Issues in the Search Interface and Areas for Future Development. Int J Technol Assess Health Care. 2022 Mar 8;38(1):e29.

(21) Dakin H. Review of studies mapping from quality of life or clinical measures to EQ-5D: an online database. Health Qual Life Outcomes. 2013;11(1):151. [Publication appraisal]

(22) Dakin H, Abel L, Burns R, Yang Y. Review and critical appraisal of studies mapping from quality of life or clinical measures to EQ-5D: an online database and application of the MAPS statement. Health Qual Life Outcomes. 2018;16:202. [Publication appraisal]

(23) Golder S, Glanville J, Ginnelly L. Populating decision-analytic models: the feasibility and efficiency of database searching for individual parameters. Int J Technol Assess Health Care 2005;21(3):305-311. [Publication appraisal]

(24) Papaioannou D, Brazier J, Paisley S. Systematic searching and selection of health state utility values from the literature. Value Health 2013;16(4):686-695. [Publication appraisal]

(25) Zechmeister-Koss I, Schnell-Inderst P, Zauner G. Appropriate evidence sources for populating decision analytic models within health technology assessment (HTA): a systematic review of HTA manuals and health economic guidelines. Med Decis Making 2014;34(3):288-299. [Publication appraisal]

(26) De Cock E, Cosmatos I, Kirsch E. Use of databases for health resource utilizaton and cost analyses in EU-5: Results from a focused literature review [abstract]. Value in Health Conference: ISPOR 21st Annual International Meeting Research Washington, DC. Value Health 2016;19(3):A80-A8). [Publication appraisal]

(27) Paisley S. Identification of evidence for key parameters in decision-analytic models of cost effectiveness: a description of sources and a recommended minimum search requirement. PharmacoEconomics. 2016;34(6):597-608. [Publication appraisal]

(28) Takada S, Narukawa M. Acceptability of Manufacturer-Proposed Utility Values for NICE Cancer Medicine Appraisals: Analysis of Manufacturers’ Information Sources. Int J Technol Assess Health Care, 38(1). [Publication appraisal]

(29) Gansen, F M. Health economic evaluations based on routine data in Germany: a systematic review. BMC Health Serv Res. 2018;18(1):268. [Publication appraisal]

(30) Husereau, D, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMJ 2022; 376: e067975.

(31) Rosen AB, Greenberg D, Stone PW, Olchanski NV, Neumann PJ. Quality of abstracts of papers reporting original cost-effectiveness analyses. Med Decis Making 2005;25:424-428. [Publication appraisal]

(32) Glanville J, Fleetwood K, Yellowlees A, Kaunelis D, Mensinkai S. Development and testing of search filters to identify economic evaluations in MEDLINE and EMBASE. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2009. [Publication appraisal]

(33) Glanville J, Kaunelis D, Mensinkai S. How well do search filters perform in identifying economic evaluations in MEDLINE and EMBASE. Int J Technol Assess Health Care 2009;25(4):522-529. [Publication appraisal]

(34) McKinlay RJ, Wilczynski NL, Haynes RB, Hedges Team. Optimal search strategies for detecting cost and economic studies in EMBASE. BMC Health Serv Res 2006;6:67. [Publication appraisal]

(35) Harboe I, Desser A, Nordheim L, Glanville, J. PD85 Testing Search Filters To Retrieve Economic Evaluations In Embase. Int J Technol Assess Health Care 2019;34(S1): 158-158. doi:10.1017/S0266462318003343 [Publication appraisal]

(36) Kaunelis D. When everything is too much: development of a CADTH narrow economic search filter. Poster presented at: 2011 CADTH Symposium. 2011 Apr 3-5; Vancouver, BC. [Publication appraisal]

(37) Droste S, Dintsios C-M. Informationsgewinnung für gesundheitsökonomische Evaluationen im Rahmen von HTA-Berichten. Gesundheitsökonomie & Qualitätsmanagement 2011;16(1):35-57. [Publication appraisal]

(38) Hinde S, Spackman E, Claxton K, Sculpher MJ. The cost-effectiveness threshold: the results of a novel literature review method. Value Health 2011;14:A354. [Publication appraisal]

(39) Brazier J, Ara R, Azzabi I, Busschbach J, Chevrou-Séverac H, Crawford B, Cruz L, Karnon J, Lloyd A, Paisley S, Pickard AS. Identification, review, and use of health state utilities in cost-effectiveness models: an ISPOR Good Practices for Outcomes Research Task Force report. Value Health. 2019 Mar;22(3):267–275. [Publication appraisal]


(40) Arber M, Garcia S, Veale T, Edwards M, Shaw A, Glanville JM. Performance of Ovid MEDLINE search filters to identify health state utility studies. Int J Technol Assess Health Care. 2017 Jan;33(4);472-80. [Publication appraisal]



How to cite this chapter:

Glanville J, Kaunelis D. Costs and economic evaluation. Last updated 2 Dec. 2022. In: SuRe Info: Summarized Research in Information Retrieval for HTA. Available from: https://www.sure-info.org//costs-and-economic-evaluation

Copyright: the authors