Components of Sustainable Health Systems: What Is Known About The Cost-Effectiveness of Clinical Care?

Abstract

Evidence to ensure cost-effective purchasing of services are an important pre-requisite for ensuring financial sustainability of health systems. The Research Agenda for Health Economic Evaluation project aims to map out the economic evidence available for the treatment of the 10 highest burden conditions in the European Union and identify evidence gaps. The 10 highest burden diseases are selected by Disability Adjusted Life Years (DALYs) based on the Global Burden of Disease study for Europe (Ischemic Heart Disease, Low Back Pain, Stroke, Major Depressive Disorder, Lung Cancer, Falls, COPD, Diabetes, Other musculoskeletal, Neck pain). Clinical pathways are generated for these conditions by merging published clinical guidelines from public and professional bodies. Economic (cost-benefit and cost-effectiveness) evidence indexed by MEDLINE is stratified by treatment pathways to identify evidence gaps. Existing reviews are analysed to assess coverage of primary evidence. Results are presented for diabetes: 1,208 articles were retrieved from MEDLINE, of which 315 mapped to the treatment pathway. Most evidence was published after 2000.74 reviews were identified, of which 24 were published between 2009-13. Volume of economic studies for each treatment ranged from 0 to 39 studies. The most intensively studied were diabetic retinopathy (n=39), foot ulcers (n=34) and renal disease (n=31). Areas with no economic evidence included non-pharmacological blood pressure and dyslipidemia control. In some cases economic evidence was available, but no recent reviews of the evidence were identified (eg. islet or pancreas transplantation, diabetic neuropathy, interventions for weight loss). Economic evidence was available for the majority of treatment modalities for diabetes, however for several treatments no studies were identified. Importantly, reviews were not identified for several treatments where economic evidence was available. Lack of economic evidence prevents cost-effective commissioning, and lack of reviews of evidence may be a further barrier to translation.