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Research Report - Final – Oct. 23, 2012
Best Practices for Conducting Economic Evaluations in Health Care: A Systematic Review of Quality Assessment Tools
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This report describes the strengths and weaknesses of checklists that have been used to evaluate best practices for conducting and reporting on economic evaluations in health care. We defined checklists as any original listing of specific items that the authors recommended be addressed in the conduct or reporting of an economic evaluation. We focused on how checklists define: (1) the criteria for judging that an economic evaluation is of sufficiently high quality to be useful; (2) the importance of different aspects of the evaluation; and (3) the extent to which high quality with respect to one aspect of an evaluation can compensate for lower quality with respect to another aspect of the evaluation.
A systematic approach was taken to search the literature through January 2012 for articles relevant to economic evaluations, outcomes, and guidelines for the decisionmaker. The following electronic databases were searched using similar search strategies: MEDLINE, EconLit, CINAHL, Embase, and ISI Web of Science. References of relevant reviews were searched for applicable articles. Experts were queried to ensure that all pertinent articles were included.
Ten peer-reviewed journal articles reported on an original checklist for assessing an economic evaluation. The first was published in 1992, and the last was published in 2011. The number of items in the checklists ranged from 11 to 57. One item, perspective, was a criterion in all 10 of the checklists. Eleven other criteria were included in seven to nine of the checklists: description of the target population, choice of alternatives, study question, study design, measurement, valuation, outcome identification, outcome measurement, adjustment for time variation, sensitivity and uncertainties, presentation of results, generalizability, and incremental analysis. Four of the checklists had evidence of excellent test-retest reliability, but none of the checklists had consistent evidence of excellent inter-rater reliability in two or more studies. Only three of the checklists had evidence of excellent criterion validity, based on comparisons between checklists or comparisons with ratings of experts in health economics.
Several well-developed checklists exist for investigators, reviewers, and journal editors to use in efforts to ensure that economic evaluations and eventual systematic reviews of economic evaluations will be more informative and transparent. The choice of an appropriate checklist should be made with the understanding that quality assessment tools will continue to evolve over time and must improve in reliability and validity for all decisionmakers.