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International lessons in new methods for grading and integrating cost effectiveness evidence into clinical practice guidelines
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Antioch, Kathryn M., Drummond, Michael F., Niessen, L.W. and Vondeling, Hindrik (2017) International lessons in new methods for grading and integrating cost effectiveness evidence into clinical practice guidelines. Cost effectiveness and resource allocation, 15 . 1. doi:10.1186/s12962-017-0063-x ISSN 1478-7547.
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Official URL: https://doi.org/10.1186/s12962-017-0063-x
Abstract
Economic evidence is influential in health technology assessment world-wide. Clinical Practice Guidelines (CPG) can enable economists to include economic information on health care provision. Application of economic evidence in CPGs, and its integration into clinical practice and national decision making is hampered by objections from professions, paucity of economic evidence or lack of policy commitment. The use of state-of-art economic methodologies will improve this. Economic evidence can be graded by ‘checklists’ to establish the best evidence for decision making given methodological rigor. New economic evaluation checklists, Multi-Criteria Decision Analyses (MCDA) and other decision criteria enable health economists to impact on decision making world-wide. We analyse the methodologies for integrating economic evidence into CPG agencies globally, including the Agency of Health Research and Quality (AHRQ) in the USA, National Health and Medical Research Council (NHMRC) and Australian political reforms. The Guidelines and Economists Network International (GENI) Board members from Australia, UK, Canada and Denmark presented the findings at the conference of the International Health Economists Association (IHEA) and we report conclusions and developments since. The Consolidated Guidelines for the Reporting of Economic Evaluations (CHEERS) 24 item check list can be used by AHRQ, NHMRC, other CPG and health organisations, in conjunction with the Drummond ten-point check list and a questionnaire that scores that checklist for grading studies, when assessing economic evidence. Cost-effectiveness Analysis (CEA) thresholds, opportunity cost and willingness-to-pay (WTP) are crucial issues for decision rules in CEA generally, including end-of-life therapies. Limitations of inter-rater reliability in checklists can be addressed by including more than one assessor to reach a consensus, especially when impacting on treatment decisions. We identify priority areas to generate economic evidence for CPGs by NHMRC, AHRQ, and other agencies. The evidence may cover demand for care issues such as involved time, logistics, innovation price, price sensitivity, substitutes and complements, WTP, absenteeism and presentism. Supply issues may include economies of scale, efficiency changes, and return on investment. Involved equity and efficiency measures may include cost-of-illness, disease burden, quality-of-life, budget impact, cost-effective ratios, net benefits and disparities in access and outcomes. Priority setting remains essential and trade-off decisions between policy criteria can be based on MCDA, both in evidence based clinical medicine and in health planning.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RA Public aspects of medicine | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | ||||||
Library of Congress Subject Headings (LCSH): | Medical technology -- Cost effectiveness., Medical care, Cost of., Medical technology -- Evaluation., Medicine -- Practice --Cost control., Clinical medicine -- Cost control., Medical care -- Cost effectiveness., Medical economics. | ||||||
Journal or Publication Title: | Cost effectiveness and resource allocation | ||||||
Publisher: | BioMed Central Ltd. | ||||||
ISSN: | 1478-7547 | ||||||
Official Date: | 10 February 2017 | ||||||
Dates: |
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Volume: | 15 | ||||||
Article Number: | 1 | ||||||
DOI: | 10.1186/s12962-017-0063-x | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 19 September 2017 | ||||||
Date of first compliant Open Access: | 20 September 2017 |
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