15.1.1  Introduction

Cochrane reviews assemble, select, critique and combine trustworthy data from multiple research studies on the effectiveness and other aspects of healthcare interventions. They can provide robust evidence on intervention effectiveness, resulting in less selectively biased, more statistically powerful information, which may be more likely to convince decision makers compared with evidence from single studies.


However, in the face of scarce resources, decision makers often need to consider not only whether an intervention works, but also whether its adoption will lead to a more efficient use of resources. The topics of Cochrane reviews cover a wide range of questions whose answers are important for the improvement of individual and public health and well-being in environments where resources are limited. Coverage of economic aspects of interventions can therefore enhance the usefulness and applicability of Cochrane reviews as a component of the basis for healthcare decision-making (Lavis 2005).


It has been argued for many years that promoting effective care without taking into account the cost of care and the value of any health gain can lead to inefficient use of public and private funds allocated to health care, which may indirectly result in harm for individuals and the public (Williams 1987). Indeed, the case can be made that Archie Cochrane, who inspired much of the systematic review movement (and of course The Cochrane Collaboration), was in favour of decision-making informed by evidence on economics aspects of interventions as well as evidence on their effectiveness. The title of Cochrane’s most famous work, his book of Rock Carling lectures, is Effectiveness and Efficiency (Cochrane 1972). Box 15.1.a contains two quotations from that book, illustrating the importance that Cochrane placed on the role of economic evidence in healthcare decision-making.