Community Guide Methods for Systematic Reviews of Economic Evidence

Abstract

Introduction: Community Guide systematic economic reviews provide information on the cost, economic benefit, cost-benefit, and cost-effectiveness of public health interventions recommended by the Community Preventive Services Task Force on the basis of evidence of effectiveness. The number and variety of economic evaluation studies in public health have grown substantially over time, contributing to methodologic challenges that required updates to the methods for Community Guide systematic economic reviews. This paper describes these updated methods.

Methods: The 9-step Community Guide economic review process includes prioritization of topic, creation of a coordination team, conceptualization of review, literature search, screening studies for inclusion, abstraction of studies, analysis of results, translation of evidence to Community Preventive Services Task Force economic findings, and dissemination of findings and evidence gaps. The methods applied in each of these steps are reported in this paper.

Results: Two published Community Guide reviews, tailored pharmacy-based interventions to improve adherence to medications for cardiovascular disease and permanent supportive housing with housing first to prevent homelessness, are used to illustrate the application of the updated methods. The Community Preventive Services Task Force reached a finding of cost-effectiveness for the first intervention and a finding of favorable cost-benefit for the second on the basis of results from the economic reviews.

Conclusions: The updated Community Guide economic systematic review methods provide transparency and improve the reliability of estimates that are used to derive a Community Preventive Services Task Force economic finding. This may in turn augment the utility of Community Guide economic reviews for communities making decisions about allocating limited resources to effective programs.

Figure 1.

Steps in a Community Guide systematic economic review process. CDC, Centers for Disease Control and Prevention; CPSTF, Community Preventive Services Task Force.

Figure 2.

Analytic frameworks for 2 Community Guide economic reviews.^{, a}Cost drivers. ^bPerspective of healthcare system. ^cPerspective of housing agency or department. ACT, assertive community treatment; BP, blood pressure; CVD, cardiovascular disease; DALY, disability-adjusted life year; ICM, intensive case management; Labs, laboratories; PCP, primary care provider; PSH, permanent supportive housing with housing first to reduce homelessness; QALY, quality-adjusted life year; ROI, return on investment; TPA, tailored pharmacy-based interventions to improve adherence to medications for cardiovascular disease.