HOW TO INCLUDE ECONOMICS IN COCHRANE REVIEW PROTOCOLS

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HOW TO INCLUDE ECONOMICS IN COCHRANE REVIEW
PROTOCOLS
16th Cochrane Colloquium, Freiburg, Germany

• Part Two Searches, assessing risk of bias and
  methodological quality, data collection and
  analysis

Campbell Cochrane Economics Methods Group
www.c-cemg.org
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Recap - Part one

• Incorporate economics perspectives into
  Background
• Formulate an Objective for a critical review of
  published and unpublished health economics
  studies
• Identify measures of resource use, costs and
  cost-effectiveness to be included in Types of
  outcome measures
• Identify types of health economics studies to be
  included in Types of studies

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Learning objectives - Part Two

• Formulate a protocol for a search strategy for
  health economics studies
• Identify tools for assessment of risk-of-bias and
  methodological quality in health economics
  studies
• Formulate a protocol for collection of data on
  resource use, costs and cost-effectiveness
• Formulate a protocol for analysis and
  presentation of results (resource use, costs and
  cost-effectiveness)

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Caveats

• Focus is on how to prepare protocol for a
  critical review of published and unpublished
  health economics studies
• No substitute for advisory support from an
  experienced health economist
• Brand new workshops comments and criticisms
  please!

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http//www.cochrane-handbook.org
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http//www.cochrane-handbook.org
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Overview

• Presentation
• Questions and discussion

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Searches Electronic searches for health
economics studies

• Electronic searches of MEDLINE, EMBASE, CINAHL
  etc. (alongside searches for studies of effects)
• Further information on methods and tools (e.g.
  search filters for health economics studies) in
  Chapter 15 of Cochrane Handbook
• Electronic searches of specialist health
  economics literature databases

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Searches Electronic searches for health
economics studies

• NHS Economic Evaluation Database (NHS EED)
• Structured abstracts of full economic evaluations
  and citation only records of partial economic
  evaluations
• 1994 onwards (selected studies for 1992 1993)

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http//www.thecochranelibrary.com
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http//www.crd.york.ac.uk/crdweb/
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http//infodoc.inserm.fr/euronheed/Publication.nsf
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Searches Electronic searches for health
economics studies

• European Network of Health Economic Evaluation
  Databases (EURONHEED)
• Structured abstracts of full economic evaluations
  and citation only records of partial economic
  evaluations
• 2000 onwards
• Some duplication with NHS EED (full economic
  evaluations)

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Searches Electronic searches for health
economics studies

• Health Economic Evaluations Database (HEED)
• The CEA Registry
• Econlit
• Paediatric Economic Database Evaluation (PEDE)

http//www.york.ac.uk/inst/crd/econ4.htm
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Searches Electronic searches for health
economics studies

• Cochrane review (protocol) - Chest physiotherapy
  for reducing respiratory morbidity in infants
  requiring ventilatory support
• Electronic searches
• Cochrane Neonatal Review Group (see Cochrane
  Neonatal Review Group, search strategy for
  Specialised Register in The Cochrane Library).
• The Cochrane Central Register of Controlled
  Trials (CENTRAL, The Cochrane Library)
• MEDLINE (1966 to present)
• EMBASE (1988 to present)
• CINAHL (1982 to present)
• PEDro (1929 to present)
• NHS Economic Evaluation Database (1992 to
  present)
• European Network of Health Economic Evaluation
  Databases (2000 to present)
• Health Economic Evaluations Database (1992 to
  present)
• CEA Registry (1976 to present)
• Econlit (1969 to present)
• Paediatric Economic Database Evaluation (1980 to
  present)

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Searches Searching other sources for health
economics studies

• Grey literature
• Sources of grey literature for studies of effects
• Online sources including significant coverage of
  economics grey literature

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Searches Searching other sources for health
economics studies

• Grey literature
• Agency for Healthcare Research and Quality (AHRQ)
  http//www.ahrq.gov/
• Research Papers in Economics (RePEc)
  http//repec.org/
• IDEAShttp//ideas.repec.org/
• This Health Management and Policy (HMIC) Database
  (Ovid Online) http//www.ovid.com/site/catalog/Da
  taBase/99.pdf
• The New York Academy of Medicine Library Grey
  Literature Reports http//www.nyam.org/library/gr
  eywhat.shtml

See http//www.nlm.nih.gov/archive/20060905/nichs
r/ehta/chapter11.htmlbiblio
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Searches Searching other sources for health
economics studies

• Grey literature
• Sources of grey literature for studies of effects
• Online sources including significant coverage of
  economics grey literature
• Working papers and reports from specialist health
  economics research centreshttp//www.york.ac.uk/i
  nst/crd/nhseedfaq02.htm

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Searches Searching other sources for health
economics studies
???

• Handsearching
• Handsearch specialist health economics journals
  (e.g. Cost-Effectiveness and Resource
  Allocation, Health Economics, Journal of
  Health Economics, Pharmacoeconomics, Value in
  Health)
• http//www.york.ac.uk/res/herc/resources/journals.
  htm
• http//www.york.ac.uk/inst/crd/nhseedfaq02.htm

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Searches Searching other sources for health
economics studies

• Reference lists
• of identified studies of effects
• of identified health economics studies
• In Revman
• Reference lists
• Reference lists of identified studies will be
  searched for additional randomised controlled
  trials and health economics studies

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Searches Searching other sources for health
economics studies

• Correspondence
• Contact CCEMG for help contacting health
  economist topic specialists?research_at_c-cemg.org
• Final stage of search process
• No details required in protocol

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Assessment of risk-of-bias in health economics
studies

• Stage 1
• Assess risk-of-bias in study generating the
  effects data used in each included full economic
  evaluation conducted alongside single, empirical
  primary studies of effects
• Use The Cochrane Collaborations tool for
  assessing risk of bias (see Chapter 8 of
  Cochrane Handbook)
• Stage 2
• Assess overall methodological quality of each
  included full or partial economic evaluation

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Assessment of risk-of-bias in health economics
studies

• Stage 2
• Assess overall methodological quality of each
  included full or partial economic evaluation

• Economic evaluations conducted alongside single,
  empirical primary studies of effects
• British Medical Journal Checklist (Drummond 1996)
• CHEC Criteria list (Evers 2005)
• Model-based economic evaluations
• Phillips checklist (Phillips 2004)http//www.ncch
  ta.org/execsumm/summ836.shtml

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Assessment of risk-of-bias in health economics
studies

• Assessment of risk of bias in included studies
• For included health economics studies,
  risk-of-bias and methodological quality will be
  assessed using the Cochrane Collaborations tool
  for assessing risk of bias (Higgins 2008), and
  either the BMJ Checklist (Drummond 1996)
  and/or the CHEC Criteria List (Evers 2005) or
  the Phillips Checklist (Phillips 2004), as
  appropriate (see Shemilt 2008).

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Assessment of risk-of-bias in health economics
studies

• Drummond MF, Jefferson TO. Guidelines for authors
  and peer reviewers of economic submissions to the
  BMJ. The BMJ Economic Evaluation Working Party.
  British Medical Journal 1996 313 275-283.
• Evers S, Goossens M, de Vet H, van Tulder M,
  Ament A. Criteria list for assessment of
  methodological quality of economic evaluations
  Consensus on Health Economic Criteria.
  International Journal of Technology Assessment in
  Health Care 2005 21 240-245.
• Higgins JPT, Altman DG (editors). Chapter 8
  Assessing risk of bias in included studies. In
  Higgins JPT, Green S (editors). Cochrane Handbook
  for Systematic Reviews of Interventions Version
  5.0.0 (updated February 2008). The Cochrane
  Collaboration, 2008. Available from
  www.cochrane-handbook.org.
• Philips Z, Ginnelly L, Sculpher M, Claxton K,
  Golder S, Riemsma R, Woolacoot N, Glanville J.
  Quality assessment in decision-analytic models a
  suggested checklist (Appendix 3). In Review of
  guidelines for good practice in decision-analytic
  modelling in health technology assessment. Health
  Technology Assessment 2004 8 36.
• Shemilt I, Mugford M, Byford S, Drummond M,
  Eisenstein E, Knapp M, Mallender J, McDaid D,
  Vale L, Walker D. Chapter 15 Incorporating
  economics evidence. In Higgins JPT, Green S
  (editors), Cochrane Handbook for Systematic
  Reviews of Interventions Version 5.0.0 (updated
  February 2008). The Cochrane Collaboration, 2008.
  Available from www.cochrane-handbook.org.

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Data extraction and management for health
economics studies

• Precise data collection requirements for the
  economics components of reviews will need to be
  determined for each individual review
• Depends on measures of resource use, costs and/or
  cost-effectiveness included in Types of outcome
  measures
• Develop data collection form based on NHS EED
  template for structured abstractshttp//www.york.
  ac.uk/inst/crd/pdf/nhseed-handb07.pdf

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Data extraction and management for health
economics studies

• Data extraction and management
• A data collection form will be developed for use
  with health economics studies, based on the
  template used to produce NHS EED structured
  abstracts (Craig 2007).
• Craig D, Rice S. CRD Report 6 NHS Economic
  Evaluation Database Handbook (3rd edition). York
  (UK) Centre for Reviews and Dissemination,
  University of York, 2007. Available from
  http//www.york.ac.uk/inst/crd/pdf/nhseed-handb07.
  pdf

http//www.york.ac.uk/inst/crd/pdf/nhseed-handb07.
pdf
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Analysis and presentation of results of health
economics studies

• Use of tables
• Use of a narrative summary

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Analysis and presentation of results of health
economics studies

• Economics issues
• Measures of resource use, costs and
  cost-effectiveness will be presented in
  additional tables, by study.
• Point estimates (mean and median), measures of
  variance, and range (minimum and maximum values)
  will be presented for measures of resource use
  and costs, alongside point estimates (mean) and
  95 confidence intervals for measures of
  incremental cost-effectiveness.
• Unit cost data will also be presented, when
  available.

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Analysis and presentation of results of health
economics studies

• Economics issues
• Measures of incremental resource use and
  incremental costs will be presented alongside
  measures of resource use and costs within each
  comparison group, by study.
• The currency and price year applicable to
  measures of costs in each original study will be
  reported alongside measures of costs, incremental
  costs and incremental cost-effectiveness, by
  study.
• Where details of currency and price year are
  available in original studies, measures of costs
  and incremental costs will be converted to 2008
  International Dollars using GDP Deflators and GDP
  Purchasing Power Parities.

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Analysis and presentation of results of health
economics studies

• Economics issues
• Details of the methodological characteristics of
  included health economics studies will be
  summarised in Characteristics of included
  studies tables.
• A narrative summary will be used to describe
  included health economics studies, to compare
  methods used and principal results between
  studies, and to discuss their methodological
  quality and limitations.

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Analysis and presentation of results of health
economics studies

• Use of tables
• Use of a narrative summary
• Meta-analysis of resource use/ costs

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Analysis and presentation of results of health
economics studies

• Economics issues
• If judged appropriate, measures of resource use
  and/ or measures of costs (continuous variables)
  will be pooled using inverse-variance fixed
  effects/ random effects/ both meta-analysis.
  Measures of costs will be adjusted to a common
  currency and price year in advance of any
  meta-analysis.

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HOW TO INCLUDE ECONOMICS IN COCHRANE REVIEW
PROTOCOLS
16th Cochrane Colloquium, Freiburg, Germany

• Part Two Searches, assessing risk of bias and
  methodological quality, data collection and
  analysis

Campbell Cochrane Economics Methods Group
www.c-cemg.org