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Open Access Methodology

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

Ian Shemilt1, David McDaid2, Kevin Marsh3, Catherine Henderson2, Evelina Bertranou4, Jacqueline Mallander4, Mike Drummond5, Miranda Mugford6, Luke Vale7* and On behalf of the Campbell and Cochrane Economics Methods Group

Author Affiliations

1 Behaviour and Health Research Unit, University of Cambridge, Robinson Way Cambridge CB2 0SR, UK

2 Personal Social Services Research Unit, London School of Economics, Houghton Street, London WC2A 2AE, UK

3 United BioSource Corporation, 26-28 Hammersmith Grove, London W6 7HA, UK

4 Matrix Knowledge, 152-160 City Road, London EC12 2NP, UK

5 Centre for Health Economics, University of York, Heslington York YO10 5DD, UK

6 Health Economics Group, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK

7 Institute of Health & Society, Newcastle University, Richardson Road, Newcastle, Upon Tyne NE2 4AX, UK

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Systematic Reviews 2013, 2:83  doi:10.1186/2046-4053-2-83

Published: 20 September 2013

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.

Keywords:
Cost-utility analysis; Cost-effectiveness analysis; Systematic review; Meta-analysis; Cochrane collaboration