15.1.3  Coverage of economics issues in Cochrane reviews

The overall aim of this chapter is to describe how authors of Cochrane and other systematic reviews might compile the best evidence on economic aspects of interventions in addition to the best evidence on their effectiveness.

 

There is currently no formal requirement for Cochrane reviews to include coverage of economic issues. This guidance is therefore presented as a series of optional methods to be considered by Cochrane review authors seeking to include coverage of economic issues. The principal element of the methodological framework outlined is a critical review of health economics studies, which can be conducted as a fully integrated component of a Cochrane review. This involves the assembly, selection, critical appraisal, summary and possibly synthesis of data from relevant health economics studies. Three core premises of the guidance are as follows:

  1. Given the international audience of end-users of Cochrane reviews, the overall aim of economics components of reviews should be to summarize what is known from different settings about economic aspects of interventions, to help end-users understand key economic trade-offs between alternative healthcare treatments or tests.

  2. Key secondary aims are to provide a framework for Cochrane reviews to present clinical and economic data in a format that facilitates their use in subsequent, or parallel, economic analyses.

  3. Economic issues are relevant to decision-making even when evidence of intervention effectiveness is unclear. First, end-users often need to be aware of evidence regarding the incremental resource use and costs associated with an intervention, versus relevant comparators, as this can help to clarify the case for investing in future research on both effectiveness and cost-effectiveness. Second, it is important for end-users to be aware of whether or not existing full economic evaluations are based on robust evidence regarding effectiveness.

 

Authors of Cochrane reviews seeking to include coverage of economic aspects of interventions will need to consider in detail, and from the earliest stages of protocol development, how economic issues relate to their specific review topic. Use of the methods described in this chapter will also require at least some training in the use of health economics methods. Therefore, once a decision to include coverage of economic issues has been taken, it is advisable to consult with a health economist who has experience of systematic review methods as soon as possible.

 

Some Cochrane Review Groups (CRGs) already have access to one or more experienced health economists who regularly contribute work on economics components of reviews. The Campbell and Cochrane Economics Methods Group (CCEMG) will seek to help authors of Cochrane reviews identify health economists willing to contribute work, or to provide advice or peer review support (see Box 15.10.a).