What should Cochrane authors, reviewers and editors do about economics methods? Ian Shemilt - Research Coordinator, CCEMG ...
 
Outline <ul><li>What are: economics; health economics; economic decisions and economic evaluations? </li></ul><ul><li>What...
<ul><li>Provision of evidence on economic aspects of health care interventions alongside evidence on their effectiveness c...
<ul><li>Integrated critical systematic review  </li></ul><ul><li>of economics studies </li></ul>Proposed methodological fr...
<ul><li>The social science that deals with the production, distributio, and consumption of goods and services and with the...
<ul><li>All  effective  care should be free </li></ul><ul><li>Cochrane AL. Introduction to  Effectiveness and Efficiency ....
<ul><li>Should people seeking health care for [???] be offered/ choose [ ??? ] instead of previous routine care [ ??? ] in...
<ul><li>A framework for the comparative analysis of alternative interventions in terms of both their costs (resource use) ...
Decision tree - health decision Caesarean: closure of peritoneum? Outcome 1 Outcome 2 Yes No
Decision tree - Costs and decisions Caesarean: closure of peritoneum? Cost 1 Cost 2 Yes No
Decision tree - economic decision Cost 1 Cost 2 Caesarean:  closure of  peritoneum? Outcome 1 Outcome 2 Yes No
<ul><li>Incremental effectiveness </li></ul><ul><li>= Outcome 1 – Outcome 2 </li></ul><ul><li>Incremental cost  </li></ul>...
<ul><li>NICE, CDC, CADTH, PBAC </li></ul>How are Cochrane systematic reviews used in economic decision making?
<ul><li>Growth in health economics literature -> increasing likelihood that Cochrane reviewers will encounter economics st...
How do Cochrane reviewers deal with economics? <ul><li>Incorporate discussion of economic aspects of interventions studied...
Key challenges to reviewers: <ul><li>Ask economics questions at the protocol stage </li></ul><ul><li>Inclusion of ‘economi...
<ul><ul><li>Handbook chapter </li></ul></ul><ul><ul><li>Research strategy </li></ul></ul><ul><ul><li>Training workshops </...
What should Cochrane authors, reviewers and editors do about economic evaluation methods? <ul><li>Look at web pages for CC...
Joan Robinson said in 1955… “ The purpose of studying economics is not to acquire a set of ready-made answers to economic ...
Visit our website at:  www.c-cemg.org Thank you for listening!
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The Cochrane Collaboration Colloquium: What should Cochrane reviewers and editors do about economic evaluation methods?

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Ian Shemilt speaking at the XIV Cochrane Colloquium in Dublin, Ireland

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The Cochrane Collaboration Colloquium: What should Cochrane reviewers and editors do about economic evaluation methods?

  1. 1. What should Cochrane authors, reviewers and editors do about economics methods? Ian Shemilt - Research Coordinator, CCEMG Miranda Mugford - Chair of Co-convenors, CCEMG
  2. 3. Outline <ul><li>What are: economics; health economics; economic decisions and economic evaluations? </li></ul><ul><li>What is the role of Cochrane reviews for informing economic decisions? </li></ul><ul><li>How do Cochrane reviewers deal with economic issues and what are the key challenges?s </li></ul><ul><li>What sorts of support can the CCEMG provide for Cochrane reviewers + editors? </li></ul>
  3. 4. <ul><li>Provision of evidence on economic aspects of health care interventions alongside evidence on their effectiveness can enhance the usefulness and applicability of Cochrane reviews as a component of the basis for decision making by the consumers of the reviews . </li></ul><ul><li>Draft Cochrane Handbook Chapter on </li></ul><ul><li>Incorporating Economics Methods (In preparation) </li></ul><ul><li>citing Lavis et al (2005) </li></ul>Objective
  4. 5. <ul><li>Integrated critical systematic review </li></ul><ul><li>of economics studies </li></ul>Proposed methodological framework
  5. 6. <ul><li>The social science that deals with the production, distributio, and consumption of goods and services and with the theory and management of economies or economic systems </li></ul><ul><li>Rhodda C. Definitions of economics and social science </li></ul><ul><li>Dismal science? </li></ul><ul><li>Cheerful science! </li></ul>What is economics?
  6. 7. <ul><li>All effective care should be free </li></ul><ul><li>Cochrane AL. Introduction to Effectiveness and Efficiency . </li></ul><ul><li>But can all effective care be provided? </li></ul><ul><li>What is the sacrifice? -> Opportunity Cost </li></ul>What is health economics?
  7. 8. <ul><li>Should people seeking health care for [???] be offered/ choose [ ??? ] instead of previous routine care [ ??? ] in the [ ??? ] health system? </li></ul><ul><li>Where will the resources come from? </li></ul><ul><li>Would the ‘loss’ from previous (alternative) use of resources be outweighed by the gain from the new use? </li></ul>What are economic decisions?
  8. 9. <ul><li>A framework for the comparative analysis of alternative interventions in terms of both their costs (resource use) and their consequences (effects) </li></ul><ul><li>Adapted from Drummond et al, 2005. </li></ul>What is economic evaluation?
  9. 10. Decision tree - health decision Caesarean: closure of peritoneum? Outcome 1 Outcome 2 Yes No
  10. 11. Decision tree - Costs and decisions Caesarean: closure of peritoneum? Cost 1 Cost 2 Yes No
  11. 12. Decision tree - economic decision Cost 1 Cost 2 Caesarean: closure of peritoneum? Outcome 1 Outcome 2 Yes No
  12. 13. <ul><li>Incremental effectiveness </li></ul><ul><li>= Outcome 1 – Outcome 2 </li></ul><ul><li>Incremental cost </li></ul><ul><li>= Cost 1 – Cost 2 </li></ul><ul><li>Cost effectiveness </li></ul><ul><li>= Incremental cost / Incremental effectiveness </li></ul>What is economic evaluation?
  13. 14. <ul><li>NICE, CDC, CADTH, PBAC </li></ul>How are Cochrane systematic reviews used in economic decision making?
  14. 15. <ul><li>Growth in health economics literature -> increasing likelihood that Cochrane reviewers will encounter economics studies </li></ul><ul><li>What do we do with ‘em??!! </li></ul>How do Cochrane reviewers deal with economics?
  15. 16. How do Cochrane reviewers deal with economics? <ul><li>Incorporate discussion of economic aspects of interventions studied </li></ul><ul><li>Incorporate a review of published economics studies (+ pooling of cost and/ or resource use data) </li></ul><ul><li>Systematic reviews of studies of economic interventions </li></ul><ul><li>Shemilt et al (In preparation) </li></ul>
  16. 17. Key challenges to reviewers: <ul><li>Ask economics questions at the protocol stage </li></ul><ul><li>Inclusion of ‘economic outcomes’ </li></ul><ul><li>Routine use of NHS EED to help identify studies </li></ul><ul><li>Quality threshold for inclusion based on use of established checklists (e.g. BMJ Checklist) </li></ul><ul><li>Critical appraisal of included economics studies </li></ul><ul><li>Adjustment of cost estimates for currency and year </li></ul><ul><li>Pooling of extracted cost and/ or resource use data </li></ul><ul><li>Sub-group analysis by country? </li></ul><ul><li>Clear + consistent reporting of economics methods. </li></ul>
  17. 18. <ul><ul><li>Handbook chapter </li></ul></ul><ul><ul><li>Research strategy </li></ul></ul><ul><ul><li>Training workshops </li></ul></ul><ul><ul><li>Web-based resources: www.c-cemg.org </li></ul></ul><ul><ul><li>Advisory economist for each review group </li></ul></ul>What sorts of support can CCEMG provide?
  18. 19. What should Cochrane authors, reviewers and editors do about economic evaluation methods? <ul><li>Look at web pages for CCEMG </li></ul><ul><li>Attend economics workshops at colloquia </li></ul><ul><li>Ask economic questions at protocol stage </li></ul><ul><li>Define level of economics planned for review </li></ul><ul><li>Explore and comment on links between C1 reviews and NHS EED </li></ul><ul><li>Seek peer review for complex economics aspects of reviews </li></ul><ul><li>Engage in methodological research with CCEMG and the Cochrane Methodology Review Group </li></ul>
  19. 20. Joan Robinson said in 1955… “ The purpose of studying economics is not to acquire a set of ready-made answers to economic questions, but… ...to learn how to avoid being deceived by economists.”
  20. 21. Visit our website at: www.c-cemg.org Thank you for listening!

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