Abstract
BackgroundMethods 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.MethodsTwo 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.ResultsThe 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.ConclusionsMethods 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.
Highlights
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
Cochrane economics methods: 1993 to 2013 and after 2013 As we reflect on the first 20 years of development of economics methods for Cochrane reviews, it is apposite to acknowledge the insight of those early leaders within The Cochrane Collaboration who recognised a need for the organisation to consider both efficiency and effectiveness perspectives
We should acknowledge the legacy of those health economists who responded to this challenge by forming, in 1993, the informal discussion group that evolved into the Campbell and Cochrane Economics Methods Group
Summary
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. Methods for systematic reviews 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?’ Systematic reviews have addressed the efficiency of those interventions less often Such questions as ‘Is it worth it?’, ‘At what cost has reflected Cochrane’s vision: Has it embraced the need to take an efficiency perspective?. Studies of cost-effectiveness may arrive at different conclusions than studies that evaluate effectiveness and costs separately [2]; ideally, consideration is needed of both effectiveness and cost together to inform judgements on cost-effectiveness
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