15.9  Conclusions

This chapter has outlined a methodological framework for incorporating evidence from health economics studies into the Cochrane review process. Whilst this exercise is extremely unlikely, and is not recommended, to produce statements about whether “intervention X is cost-effective”, it can help decision makers to understand the structure of the resource allocation problem they are addressing, the main parameters that need to be considered, variation between settings in terms of resource use, costs and cost-effectiveness, and potential reasons for these variations (Drummond 2002). Incorporating economics evidence can also enhance the usefulness and applicability of Cochrane reviews as a source of data for subsequent (or parallel) full economic evaluations. It is anticipated that this guidance will continue to be refined and updated as a result of being subjected to further criticism from a wider audience, and as the methods continue to develop based on experience of their use in Cochrane reviews and further methodological research.


The process of developing this guidance has also helped to clarify key priorities for further research aiming to develop and test alternative methods for the identification, appraisal, analysis and presentation of evidence on economic aspects of interventions. Key research priorities include: further development of a balance-sheet approach to summarizing the results of economics components of reviews, evaluation of the impact on the results of economic reviews of applying different methodological quality criteria or thresholds for inclusion of economic evaluation studies, and evaluation of methods which utilize individual-level data to investigate and deal with heterogeneity between settings in resource use, costs and utilities (and other measures of preferences for health states). These and other methods research priorities are listed on the ‘Research’ pages of the CCEMG web site (see Box 15.10.a).