Abstract
BackgroundHealth economic evaluations support the health care decision-making process by providing information on costs and consequences of health interventions. The quality of such studies is assessed by health economic evaluation (HEE) quality appraisal instruments. At present, there is no instrument for measuring and improving the quality of such HEE quality appraisal instruments. Therefore, the objectives of this study are to establish a framework for assessing the quality of HEE quality appraisal instruments to support and improve their quality, and to apply this framework to those HEE quality appraisal instruments which have been subject to more scrutiny than others, in order to test the framework and to demonstrate the shortcomings of existing HEE quality appraisal instruments.MethodsTo develop the quality assessment framework for HEE quality appraisal instruments, the experiences of using appraisal tools for clinical guidelines are used. Based on a deductive iterative process, clinical guideline appraisal instruments identified through literature search are reviewed, consolidated, and adapted to produce the final quality assessment framework for HEE quality appraisal instruments.ResultsThe final quality assessment framework for HEE quality appraisal instruments consists of 36 items organized within 7 dimensions, each of which captures a specific domain of quality. Applying the quality assessment framework to four existing HEE quality appraisal instruments, it is found that these four quality appraisal instruments are of variable quality.ConclusionsThe framework described in this study should be regarded as a starting point for appraising the quality of HEE quality appraisal instruments. This framework can be used by HEE quality appraisal instrument producers to support and improve the quality and acceptance of existing and future HEE quality appraisal instruments. By applying this framework, users of HEE quality appraisal instruments can become aware of methodological deficiencies inherent in existing HEE quality appraisal instruments. These shortcomings of existing HEE quality appraisal instruments are illustrated by the pilot test.
Highlights
Health economic evaluations support the health care decision-making process by providing information on costs and consequences of health interventions
Framework for quality assessment of health economic evaluation (HEE) quality appraisal instruments The framework consists of 36 items organized within 7 dimensions, each of which captures a specific domain of quality: Dimension A (“purpose and scope”, items A1A5), Dimension B (“stakeholder involvement”, items B1-B3), Dimension C (“rigor of development process/ validity”, items C1-C8c), Dimension D (“reliability/ reproducibility”, items D1-D4d), Dimension E (“clarity of presentation”, items E1-4), Dimension F (“applicability”, items F1-F5), Dimension G (“evaluation”, items G1G2)
Application of the quality assessment framework To test the established framework and to demonstrate the shortcomings of existing HEE quality appraisal instruments, four well-known, often-cited, and widely-used HEE quality appraisal instruments, which have been subject to relatively more scrutiny than most others, were selected: the Quality of Health Economic Studies (QHES) instrument developed by Chiou et al [21], the British Medical Journal (BMJ) guidelines for economic submissions established by Drummond and Jefferson on behalf of the BMJ Economic Evaluation Working Party [22], the Consensus on Health Economic Criteria (CHEC) list devised by Evers et al [23], and the Good Practice Guidelines for Decision-Analytic Modeling accomplished by Philips et al [24]
Summary
Health economic evaluations support the health care decision-making process by providing information on costs and consequences of health interventions The quality of such studies is assessed by health economic evaluation (HEE) quality appraisal instruments. There is no instrument for measuring and improving the quality of such HEE quality appraisal instruments. The objectives of this study are to establish a framework for assessing the quality of HEE quality appraisal instruments to support and improve their quality, and to apply this framework to those HEE quality appraisal instruments which have been subject to more scrutiny than others, in order to test the framework and to demonstrate the shortcomings of existing HEE quality appraisal instruments.
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