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. 2013 Sep 20:2:83.
doi: 10.1186/2046-4053-2-83.

Issues in the incorporation of economic perspectives and evidence into Cochrane reviews

Ian Shemilt  1 , David McDaid, Kevin Marsh, Catherine Henderson, Evelina Bertranou, Jacqueline Mallander, Mike Drummond, Miranda Mugford, Luke Vale; Campbell and Cochrane Economics Methods Group
Affiliations

Issues in the incorporation of economic perspectives and evidence into Cochrane reviews

Ian Shemilt et al. Syst Rev. .

Abstract

Background: Methods for systematic reviews of the effects of health interventions have focused mainly on addressing the question of 'What works?' or 'Is this intervention effective in achieving one or more specific outcomes?' Addressing the question 'Is it worth it given the resources available?' has received less attention. This latter question can be addressed by applying an economic lens to the systematic review process.This paper reflects on the value and desire for the consideration by end users for coverage of an economic perspective in a Cochrane review and outlines two potential approaches and future directions.

Methods: Two frameworks to guide review authors who are seeking to include an economic perspective are outlined. The first involves conducting a full systematic review of economic evaluations that is integrated into a review of intervention effects. The second involves developing a brief economic commentary. The two approaches share a set of common stages but allow the tailoring of the economic component of the Cochrane review to the skills and resources available to the review team.

Results: The number of studies using the methods outlined in the paper is limited, and further examples are needed both to explore the value of these approaches and to further develop them. The rate of progress will hinge on the organisational leadership, capacity and resources available to the CCEMG, author teams and other Cochrane entities. Particular methodological challenges to overcome relate to understanding the key economic trade-offs and casual relationships for a given decision problem and informing the development of evaluations designed to support local decision-makers.

Conclusions: Methods for incorporating economic perspectives and evidence into Cochrane intervention reviews are established. Their role is not to provide a precise estimate of 'cost-effectiveness' but rather to help end-users of Cochrane reviews to determine the implications of the economic components of reviews for their own specific decisions.

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Figures

Figure 1
Figure 1
Decision-making relationship between effectiveness and cost*. *In this respect, we gratefully acknowledge other members of the Cochrane Health Economics Group: especially Ron Akehurst, Martin Buxton, Iain Chalmers, Ray Churnside, Paul Fenn, John Forbes, Alastair Gray, Jane Griffin, Sarah Howard, Tom Jefferson, Alastair McGuire, Bernie O’Brien, Andy Oxman and Adrian Towse who formulated this figure at the inaugural meeting of the group in 1993.
Figure 2
Figure 2
Framework for incorporating economic perspectives into Cochrane intervention reviews: aims and assembly of data.
Figure 3
Figure 3
Framework for incorporating economic perspectives into Cochrane intervention reviews: presentation of economic data.
See this image and copyright information in PMC

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