Reporting health economic evaluations: CHEERS and beyond

Health economic evaluations are relevant to those making healthcare resource allocation decisions, such as listing a new drug on the national formulary or launching a new vaccination programme. Compared with clinical studies that report only the health consequences of an intervention, economic evaluations require more space to report additional items such as resource use, costs, preference-related information, and cost effectiveness results. This creates challenges for editors, peer reviewers, and those who wish to scrutinise a study’s findings. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) updated previous efforts to produce a single useful reporting standard. It received endorsement from, and was co-published in, 10 journals that frequently publish health economic evaluations. CHEERS provides a sound basis for improving the reporting of economic evaluations

Oncology modeling for fun and profit! Key steps for busy analysts in health technology assessment

In evaluating new oncology medicines, two common modeling approaches are state transition (e.g., Markov and semi-Markov) and partitioned survival. Partitioned survival models have become more prominent in oncology health technology assessment processes in recent years. Our experience in conducting and evaluating models for economic evaluation has highlighted many important and practical pitfalls. As there is little guidance available on best practices for those who wish to conduct them, we provide guidance in the form of 'Key steps for busy analysts,' who may have very little time and require highly favorable results. Our guidance highlights the continued need for rigorous conduct and transparent reporting of economic evaluations regardless of the modeling approach taken, and the importance of modeling that better reflects reality, which includes better approaches to considering plausibility, estimating relative treatment effects, dealing with post-progression effects, and appropriate characterization of the uncertainty from modeling itself

Study on the concentration, distribution, and persistence of health spending for the contributory scheme in Colombia

Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for over 19 million users of Colombia’s health system between 2013 and 2021 (contributory scheme). We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied multivariate statistical techniques such as multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until 60 years, accelerating thereafter abruptly. Health conditions with the highest percentage of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in Amazonía-Orinoquía is almost non-existent, and that outpatient care represents a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure from one year to the next (i.e. they can provide relevant information for prediction), especially in areas with a larger supply of health services such as Bogotá-Cundinamarca. To the authors’ knowledge, this is the most comprehensive and detailed micro-analysis of health spending that has been developed for a Latin American country to date

Guía para relato de estudios de evaluación econômica

O estudo apresenta um roteiro para relato de estudos de avaliação econômica

Rosiglitazone and Myocardial Infarction in Patients Previously Prescribed Metformin

Objective: Rosiglitazone was found associated with approximately a 43% increase in risk of acute myocardial infarction (AMI) in a two meta-analyses of clinical trials. Our objective is to estimate the magnitude of the association in real-world patients previously treated with metformin. Research Design and Methods: We conducted a nested case control study in British Columbia using health care databases on 4.3 million people. Our cohort consisted of 158,578 patients with Type 2 diabetes who used metformin as first-line drug treatment. We matched 2,244 cases of myocardial infarction (AMI) with up to 4 controls. Conditional logistic regression models were used to estimate matched odds ratios for AMI associated with treatment with rosiglitazone, pioglitazone and sulfonylureas. Results: In our cohort of prior metformin users, adding rosiglitazone for up to 6 months was not associated with an increased risk of AMI compared to adding a sulfonylurea (odds ratio [OR] 1.38; 95% confidence interval [CI], 0.91–2.10), or compared to adding pioglitazone (OR for rosi versus pio 1.41; 95% CI, 0.74–2.66). There were also no significant differences between rosiglitazone, pioglitazone and sulfonylureas for longer durations of treatment. Though not significantly different from sulfonylureas, there was a transient increase in AMI risk associated with the first 6 months of treatment with a glitazone compared to not using the treatment (OR 1.53; 95% CI, 1.13–2.07) Conclusions: In our British Columbia cohort of patients who received metformin as first-line pharmacotherapy for Type 2 diabetes mellitus, further treatment with rosiglitazone did not increase the risk of AMI compared to patients who were treated with pioglitazone or a sulfonylurea. Though not statistically significantly different compared from each other, an increased risk of AMI observed after starting rosiglitazone or sulfonylureas is a matter of concern that requires more research

Wait times among patients with symptomatic carotid artery stenosis requiring carotid endarterectomy for stroke prevention

BackgroundCurrent Canadian and international guidelines suggest patients with transient ischemic attack (TIA) or nondisabling stroke and ipsilateral internal carotid artery stenosis of 50% to 99% should be offered carotid endarterectomy (CEA) ≤2 weeks of the incident TIA or stroke. The objective of the study was to identify whether these goals are being met and the factors that most influence wait times.MethodsPatients who underwent CEA at the Ottawa Hospital for symptomatic carotid artery stenosis from 2008 to 2010 were identified. Time intervals based on the dates of initial symptoms, referral to and visit with a vascular surgeon, the decision to operate, and the date of surgery were recorded for each patient. The influence of various factors on wait times was explored, including age, sex, type of index event, referring physician, distance from the surgical center, degree of stenosis, and surgeon assigned.ResultsOf the 117 patients who underwent CEA, 92 (78.6%) were symptomatic. The median time from onset of symptoms to surgery for all patients was 79 days (interquartile range [IQR], 34-161). The shortest wait times were observed in stroke patients (49 [IQR, 27-81] days) and inpatient referrals (66 [IQR, 25-103] days). Only 7 of the 92 symptomatic patients (8%) received care within the recommended 2 weeks. The median surgical wait time for all patients was 14 days (IQR, 8-25 days). In the multivariable analysis, significant predictors of longer wait times included retinal TIA (P = .003), outpatient referrals (P = .004), and distance from the center (P = .008). Patients who presented to the emergency department had the shortest delays in seeing a vascular surgeon and subsequently undergoing CEA (P < .0001). There was no difference between surgeons for wait times to be seen in the clinic; however, there were significant differences among surgeons once the decision was made to proceed with CEA.ConclusionsOur wait times for CEA currently do not fall within the recommended 2-week guideline nor does it appear feasible within the current system. Important factors contributing to delays include outpatient referrals, living farther from the hospital, and presenting with a retinal TIA (amaurosis fugax). Our findings also suggest better scheduling practices once a decision is made to operate can modestly improve overall and surgical wait times for CEA

Transparency, openness, and reproducible research practices are frequently underused in health economic evaluations

Objectives: To investigate the extent to which articles of economic evaluations of healthcare interventions indexed in MEDLINE incorporate research practices that promote transparency, openness, and reproducibility. Study design and setting: We evaluated a random sample of health economic evaluations indexed in MEDLINE during 2019. We included articles written in English reporting an incremental cost-effectiveness ratio in terms of costs per life years gained, quality-adjusted life years, and/or disability-adjusted life years. Reproducible research practices, openness, and transparency in each article were extracted in duplicate. We explored whether reproducible research practices were associated with self-report use of a guideline. Results: We included 200 studies published in 147 journals. Almost half were published as open access articles (n = 93; 47%). Most studies (n = 150; 75%) were model-based economic evaluations. In 109 (55%) studies, authors self-reported use a guideline (e.g., for study conduct or reporting). Few studies (n = 31; 16%) reported working from a protocol. In 112 (56%) studies, authors reported the data needed to recreate the incremental cost-effectiveness ratio for the base case analysis. This percentage was higher in studies using a guideline than studies not using a guideline (72/109 [66%] with guideline vs. 40/91 [44%] without guideline; risk ratio 1.50, 95% confidence interval 1.15-1.97). Only 10 (5%) studies mentioned access to raw data and analytic code for reanalyses. Conclusion: Transparency, openness, and reproducible research practices are frequently underused in health economic evaluations. This study provides baseline data to compare future progress in the field.F.C-L. is supported by the Institute of Health Carlos III/CIBERSAM. D.M. is supported by a University Research Chair, University of Ottawa. The funders were not involved in the design of the study or de cision to submit the manuscript for publication, nor they were involved in aspect of the study conduct. The views expressed in this manuscript are those of the authors and may not be understood or quoted as being made on behalf of, or reflection of the position of, the funder(s) or any institution.S

Estándares Consolidados de Reporte de Evaluaciones Económicas Sanitarias: adaptación al español de la lista de comprobación CHEERS 2022

Objectives: Health economic evaluations (HEEs) are comparative analyses of courses of action in terms of both costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) original version and its adaptation to Spanish were published in 2013. Its objectives were to promote that the HEEs are identifiable, interpretable, and useful for decision making and serve as a reporting guide. The new CHEERS 2022 replaces the previous one and tries to be more easily applied to any HEE and incorporates recent methodological advances and the importance of stakeholder involvement including patients and the general public. Methods: For the present adaptation, the following stages were followed: (1) independent translations of the original list into Spanish, (2) blind back-translations, (3) evaluation of their quality, (4) preparation of a new version in Spanish, (5) review and improvement by the author team, (6) preparation of a new version in Spanish, (7) distribution of the preliminary Spanish version and the original one to the American HTA Network (Red de las Américas de Evaluación de Tecnologías Sanitarias) and Spanish-speaking experts for evaluation and feedback, (8) monitoring of changes to the original list under peer review at British Medical Journal, and (9) consolidation of the final adaptation of the Spanish CHEERS 2022 checklist. Results: In this article, we detail the process and the Spanish adaptation of the 28-item CHEERS 2022 checklist and its recommendations. Conclusions: This list is intended for researchers reporting HEE in peer-reviewed journals and reviewers, editors, and, among others, health technology assessment bodies.Fil: Augustovski, Federico Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: García Martí, Sebastián. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina. Universidad de Buenos Aires; ArgentinaFil: Espinoza, Manuel A.. Pontificia Universidad Católica de Chile; ChileFil: Palacios, Alfredo. Instituto de Efectividad Clínica y Sanitaria; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Económicas; ArgentinaFil: Husereau, Don. Institute Of Health Economics; Canadá. University of Ottawa; CanadáFil: Pichón-riviere, Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina. Universidad de Buenos Aires. Facultad de Medicina; Argentin

Consolidated health economic evaluation reporting standards (CHEERS) statement

&lt;p&gt;Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication.&lt;/p&gt; &lt;p&gt;The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (www.ispor.org/TaskForces/EconomicPubGuidelines.asp).&lt;/p&gt; &lt;p&gt;We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.&lt;/p&gt

A Systematic Review of Cost-Sharing Strategies Used within Publicly-Funded Drug Plans in Member Countries of the Organisation for Economic Co-Operation and Development

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