Health Economic Evaluation Studies Research Articles

A systematic review of models used in cost-effectiveness analyses of preventing osteoporotic fractures

This review was aimed at the evolution of health economic models used in evaluations of clinical approaches aimed at preventing osteoporotic fractures. Models have improved, with medical continuance becoming increasingly recognized as a contributor to health and economic outcomes, as well as advancements in epidemiological data. Model-based health economic evaluation studies are increasingly used to investigate the cost-effectiveness of osteoporotic fracture preventions and treatments. The objective of this study was to carry out a systematic review of the evolution of health economic models used in the evaluation of osteoporotic fracture preventions. Electronic searches within MEDLINE and EMBASE were carried out using a predefined search strategy. Inclusion and exclusion criteria were used to select relevant studies. References listed of included studies were searched to identify any potential study that was not captured in our electronic search. Data on country, interventions, type of fracture prevention, evaluation perspective, type of model, time horizon, fracture sites, expressed costs, types of costs included, and effectiveness measurement were extracted. Seventy-four models were described in 104 publications, of which 69% were European. Earlier models focused mainly on hip, vertebral, and wrist fracture, but later models included multiple fracture sites (humerus, pelvis, tibia, and other fractures). Modeling techniques have evolved from simple decision trees, through deterministic Markov processes to individual patient simulation models accounting for uncertainty in multiple parameters. Treatment continuance has been increasingly taken into account in the models in the last decade. Models have evolved in their complexity and emphasis, with medical continuance becoming increasingly recognized as a contributor to health and economic outcomes. This evolution may be driven in part by the desire to capture all the important differentiating characteristics of medications under scrutiny, as well as the advancement in epidemiological data relevant to osteoporosis fractures.

Präferenzbasierte Lebensqualitätsmessung: Der EQ-5D Fragebogen

The EQ-5D is a standardised preference-based instrument to measure health-related quality of life (HRQoL). It provides a simple descriptive profile and a one-dimensional index score for health status. Designed for self-completion by respondents, the EQ-5D can be used in population health surveys, clinical studies and economic evaluation of health care. The EQ-5D descriptive system consists of five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression), each of which comprises three levels (no problems, some or moderate problems, extreme problems or unable). This information can be used as an EQ-5D health profile for individuals or groups. Moreover, the descriptive information can be converted into a one-dimensional index score, using scoring functions based on value sets elicited from general population samples. Sets of values are available for several countries, including the United Kingdom, the United States and Germany. A comparison of different value sets suggests that values are related to cultural differences. Thus, where EQ-5D value sets for the relevant population exist then this set should be used index scores for use in national health-economic evaluation studies this country-specific value sets can be applied to provide EQ-5D preference weights for use in health-economic evaluation studies. Recently, the EuroQol Group derived a European value set, based on data collected in six Western European countries (Finland, Germany, The Netherlands, Spain, Sweden and the UK). Scores based on the European scoring function can be used in multi-national studies.

The state of health economic and pharmacoeconomic evaluation research in Zimbabwe: A review

BACKGROUND: Economic evaluation of health care has developed into a substantial body of work, and its contribution to medical decision making is increasingly being recognized. OBJECTIVE: The aim of the study was to describe the characteristics and quality of health economic (including pharmacoeconomic) evaluation research studies related to Zimbabwe. METHODS: A review of the literature was conducted to identify published health economic evaluation studies related to Zimbabwe. HEED, PubMed, MEDLINE, HealthSTAR, EconLit, and PsycINFO databases and sociological and dissertation abstracts were used to search for economic analyses. The searches used the following terms alone and in combination: costs, budgets, fee, economics, health, pharmacy, pharmacy services, medicines, drugs, health economics, cost-effectiveness, cost-benefit, cost-minimization, cost utility analysis, and Zimbabwe. Only original applied economic evaluations addressing a health-related topic pertaining to Zimbabwe and published in full were included. Two reviewers independently evaluated and scored each study in the final sample using the data collection form designed for the study. RESULTS: Fifty-nine studies were identified in the database searches, 18 of which were excluded because they were not about Zimbabwe (3 studies) or were not health related (15). Of the 41 remaining studies, 8 were excluded after further review because they were not original research, 6 because they were not economic analyses, and 1 because it was not about Zimbabwe. The final 26 studies appeared in 13 different journals (based mostly [17 (65%)] outside of Zimbabwe). The mean (SD) number of authors of each study was 3.36 (2.13); most of the authors had medical/clinical training. The number of studies peaked between 1994 and 1997. Based on a 10-point scale, with 10 indicating the highest quality, the mean (SD) quality score for all studies was 5.40 (1.56); 8 of the studies (31%) were considered to be of poor quality (score ≤4). The quality of the studies reviewed was significantly (all, P < 0.05) associated with the country in which the journal was based (non-Zimbabwe = higher), the primary health intervention (services>pharmaceutical interventions), the number of authors (more authors = higher), and year of publication (more recent = higher). CONCLUSION: This study indicated that the use of health economic (including pharmacoeconomic) evaluation research in Zimbabwe was low, and 31 % of the studies were of poor quality. More and better quality health economic research in Zimbabwe is warranted.

The CHESME Health Economic Evaluations Database (CHESME HEED) project

Health economic evaluation is becoming an increasingly influential aspect of health technology assessment, both in Europe as well as worldwide [3, 6, 11-13]. This continuously increasing influence is partly revealed by the rapid growth of the international health economic evaluation literature, and mainly by the introduction of national health technology assessment agencies in several countries that explicitly require the cost-effectiveness of health-care interventions to be demonstrated before they are approved for use in the health-care system. Nevertheless, research in European countries indicates that the use of economic evaluation in health-care decision making still remains limited, and there is certainly room for improvement [3, 6, 11]. In Greece, relatively little health economic evaluation has been undertaken so far [14], and preliminary evidence from ongoing research suggests that its impact in decision making has been trivial (if any). One would expect that this rapid increase in the number of health economic evaluation studies would provide us with more information regarding the cost-effectiveness of competing health technologies, leading in this way to more rational health-care decision making. However, after a certain degree, this increase may ultimately constitute an important obstacle to the detection of information relevant to the interested user as the total amount of information is

Comparing preference-based quality-of-life measures: results from rehabilitation patients with musculoskeletal, cardiovascular, or psychosomatic disorders

To compare the EQ-5D, 15D, HUI 2, HUI 3, SF-6D, and QWB-SA in terms of their descriptive statistics, score distribution, agreement and responsiveness in a sample of German rehabilitation inpatients. Patients with musculoskeletal (N = 106), cardiovascular (N = 88), and psychosomatic (N = 70) disorders completed questionnaires at the beginning (baseline) and end (follow-up) of their inpatient treatment. Comparisons addressed the proportion of missing data, distributional properties, agreement, and responsiveness. Intraclass correlation coefficients (ICC), paired t-tests, and standardized response means (SRM) were computed. Mean index scores at baseline ranged from 0.48 (HUI 3; psychosomatic) to 0.86 (15D; cardiovascular). At baseline, ceiling effects across all patient groups ranged from zero (SF-6D; cardiovascular and psychosomatic) to 21.6% (EQ-5D; cardiovascular). ICCs ranged from 0.26 (EQ-5D-QWB-SA; cardiovascular) to 0.80 (HUI 2-HUI 3; musculoskeletal). Substantial differences in responsiveness were observed between measures. Results obtained with different preference-based quality-of-life measures in a sample of patients with mild to moderate disease severity are not equivalent. As differences between measures may have considerable effects in health economic evaluation studies, careful selection of instruments for a given study is essential.

Health economic evaluations: How to find them

The aim of this study was to demonstrate the best way of identifying all relevant published health economic evaluation studies, which have increased in number rapidly in the past few decades. Nevertheless, health technology assessment projects are often faced with a scarcity of relevant studies. Six bibliographic databases were searched using various individually adapted strategies. The particular example involves the cost-effectiveness of diagnosing gastroesophageal reflux disease. Inclusion and exclusion criteria were formulated. After irrelevant studies and duplicates had been excluded, sixty-eight abstracts were reviewed. We chose forty-one of them as relevant for full-text review, which identified fourteen papers as having met the inclusion criteria. Most of the relevant studies were identified by searching the National Health Service Economic Evaluation Database (NHS EED) and PubMed databases. A search in NHS EED, by means of the Cochrane Library or the Center for Reviews and Dissimination, along with a supplementary search in PubMed, is generally an appropriate, cost-effective strategy. However, because "cost-effectiveness" is not consistently indexed with Medical Subject Heading terms in PubMed, all economic search terms need to be used to fully identify the relevant references.

The Diffusion of Health Economics Knowledge in Europe

This paper overviews the EURONHEED (EUROpean Network of Health Economics Evaluation Databases) project. Launched in 2003, this project is funded by the EU. Its aim is to create a network of national and international databases dedicated to health economic evaluation of health services and innovations. Seven centres (France, Germany, Italy, The Netherlands, Spain, Sweden and the UK) are involved covering 17 countries. The network is based on two existing databases, the French CODECS (COnnaissance et Decision en EConomie de la Sante) database, created in 2000 by the French Health Economists Association (College des Economistes de la Sante), and the UK NHS-EED (NHS Economic Electronic Database), run by the Centre for Reviews and Dissemination, University of York, York, England. The network will provide bibliographic records of published full health economic evaluation studies (cost-benefit, cost-utility and cost-effectiveness studies) as well as cost studies, methodological articles and review papers. Moreover, a structured abstract of full evaluation studies will be provided to users, allowing them access to a detailed description of each study and to a commentary stressing the implications and limits, for decision making, of the study. Access will be free of charge. The database features and its ease of access (via the internet: http://www.euronheed.org) should facilitate the diffusion of existing economic evidence on health services and the generalisation of common standards in the field at the European level, thereby improving the quality, generalisability and transferability of results across countries.