Candidate for the Lee B. Lusted Student Prize Competition
Purpose: There is growing recognition that current synthesis methods used in systematic reviews of economic evaluations lack value in informing funding decisions at a local level. Three methods for use alongside systematic reviews of economic evaluations of health technologies are presented, which are argued to improve knowledge translation and assist in evidence based decision-making.
Method: A review and critique of the current synthesis methods used in systematic reviews of economic evaluations was conducted. Three main shortcomings were identified: 1) narrative synthesis is most commonly employed; however the information is seldom presented for a specific decision context; 2) reviews infrequently attempt to identify differences in resource use or costs across jurisdictions and 3) the quality of data sources is rarely reported, impeding an assessment of the validity and reliability of individual study results. These inadequacies limit the usefulness of these reviews and make it difficult for decision makers to derive conclusions about cost-effectiveness for a specific jurisdiction. To improve the value of systematic reviews three methods are proposed.
Result: Initially the hierarchy of clinical evidence is expanded and modified for other data inputs used in decision modeling (resource use/costs and utilities). These hierarchies provide decision makers with a reference for judging the credibility of model results and increase confidence in the ultimate recommendation. The second method uses meta-regression techniques to pool resource use and cost data included in decision models in order to identify heterogeneity and jurisdiction specific economic impacts. By defining the factors responsible for differences in cost, decision makers can evaluate the potential economic impact of their decision in context. Finally, a presentation method that frames information in a decision context, providing an overall quality score combined with color-coding, symbols and bullet points was developed. This method provides a high-level summary of the key information required by decision makers to derive reliable conclusions about cost-effectiveness from a heterogeneous group of studies.
Conclusion: The proposed approach aims to improve the local understanding and usefulness of existing cost-effectiveness evidence from systematic reviews of the literature. The uptake of these methods by researchers will reveal the true value of these studies and result in an improved translation of economic evaluation evidence.
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