9.8.4 Economic Evaluations

Economic Evaluations: Critically Appraises Economic Evaluations

Economic evaluations are important tools that help inform healthcare decision-making by weighing the costs and benefits of different interventions. They involve the comparison of the costs and effects of different healthcare interventions to determine which option provides the greatest value for money. Critical appraisal of economic evaluations is important to ensure that the results are reliable, valid and relevant to clinical practice.

When critically appraising economic evaluations, the following elements should be considered:

• Study design: Economic evaluations may take different forms such as cost-effectiveness, cost-benefit or cost-utility analyses. The study design should be appropriate to answer the research question and the analysis should be conducted in accordance with established guidelines, such as the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).

• Perspective: The perspective adopted in the analysis should be clear, as different perspectives may result in different results. Common perspectives include the healthcare system, society, or the patient.

• Costs: All relevant costs associated with the intervention and comparator should be identified and valued appropriately. Costs may be direct (such as medication costs, and hospitalisation costs) or indirect (such as lost productivity).

• Outcomes: Outcomes should be measured and valued using appropriate methods. Health-related quality-of-life measures such as Quality-Adjusted Life Years (QALYs) are commonly used in economic evaluations.

• Uncertainty: The analysis should acknowledge and account for uncertainty in the data and assumptions made. Sensitivity analysis can be used to test the robustness of the results to different assumptions.

• Generalisability: The study population, intervention and setting should be clearly described to determine the generalisability of the results to other populations and settings.

• Interpretation and reporting: The results should be reported clearly and transparently, and the limitations of the study should be acknowledged.

One useful tool for assessing the quality of economic evaluations is the Drummond checklist, which includes 35 questions covering the above elements as well as other considerations such as time horizon, discounting and transferability of results.

Summary of critical appraisal of economic evaluations:

Study Design	Key Considerations	Strengths	Limitations
Cost-effectiveness analysis (CEA)	Use of a well-defined measure of effectiveness Comparing costs and consequences of two or more interventions Identification, measurement and valuation of costs and benefits	Provides a measure of cost-effectiveness Useful in decision-making regarding the allocation of resources	Relies on the validity of the measure of effectiveness Difficulty in measuring and valuing non-health benefits and costs May not capture long-term effects
Cost-utility analysis (CUA)	Use of quality-adjusted life years (QALYs) as a measure of effectiveness Comparing costs and consequences of two or more interventions Identification, measurement and valuation of costs and benefits	Provides a measure of cost-effectiveness that accounts for both quality and quantity of life Useful in decision-making regarding allocation of resources	Relies on the validity of the measure of QALYs Difficulty in measuring and valuing non-health benefits and costs May not capture long-term effects
Cost-benefit analysis (CBA)	Comparing costs and benefits of two or more interventions Identification, measurement and valuation of costs and benefits in monetary terms	Provides a measure of cost-effectiveness that accounts for both monetary costs and benefits Useful in decision-making regarding the allocation of resources	Requires the identification and valuation of all costs and benefits, including those that are difficult to quantify May not capture long-term effects
Cost-consequence analysis (CCA)	Separation of costs and consequences into distinct categories without combining them into a single measure	Provides detailed information about costs and consequences that can be useful for decision-making	Does not provide a single measure of cost-effectiveness May not capture long-term effects Difficult to compare results across studies

It is important to note that economic evaluations are just one piece of information that should be considered in healthcare decision-making, alongside other factors such as clinical effectiveness, safety, patient preferences and equity considerations.

References:

1. Drummond MF, et al. Methods for the Economic Evaluation of Health Care Programmes. Fourth edition. Oxford University Press, 2015.