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SEARCHING FOR HEALTH ECONOMIC EVALUATIONS
NEW SKILLS?
HTAi Seoul 2013
Pre-conference workshop June 16th
Ingrid Harboe, Research Librarian
Agenda
1. Background
2. Objective of the project
3. Definition of Economic Evaluations
4. Method guidances on searching
5. Today's practice at NOKC
6. Challenges identifying Economic Evaluations and Models
7. Need for new search strategies?
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1. Background
Increasing demand for Health technology assessments (HTAs) including economic evaluations and economic models
Health technology assessment agencies (like NOKC) need access to evidence from economic evaluations to identify the cost-effectiveness of a technology and to inform economic models
Glanville J et al 2009. Development and Testing of Search Filters to Identify Economic Evaluations in MEDLINE and EMBASE. Available from: http://www.cadth.ca/media/pdf/H0490_Search_Filters_for_Economic_Evaluations_mg_e.pdf
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Background (2)
Health economic databases - NHS EED
General databases – Embase, MEDLINE
Sensitive search filters
Identifying evidence to inform economic models
Different approach searching for “Quality of Life” studies?
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2. Objective
How can we improve our search methods to identify economic evaluations and economic models at the Norwegian Knowledge Centre?
Our special topic of interest is identifying QALYs (Quality Adjusted Life Year values)
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3. Definition of Economic Evaluations
Studies comparing two or more interventions (alternatives) is undertaken
Costs and outcomes are examined for each intervention
Results measured as costs per unit of benefit
Economic evaluations can be classified as
– Cost-effectiveness analysis
– Cost-utility analysis
– Cost-benefit analysis
Glanville J et al 2009. Development and Testing of Search Filters to Identify Economic Evaluations in MEDLINE and EMBASE. Available from:
http://www.cadth.ca/media/pdf/H0490_Search_Filters_for_Economic_Evaluations_mg_e.pdf
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Economic Evaluations (2)
Cost-effectiveness analyses (CEA)
Health outcomes measured in natural (health) units; generic (life-years gained); disease specific (strokes avoided)
Cost-utility analyses (CUA) is a subgroup of CEA Outcomes measured as health-related preferences Quality adjusted life years gained (QALYs) QALY values measure the quality and duration of survival
Cost-benefit analyses (CBA) Values costs and outcomes in monetary terms Rarely used for economic evaluations in the health sector
Glanville J et al 2009. Development and Testing of Search Filters to Identify Economic Evaluations in MEDLINE and EMBASE. Available from: http://www.cadth.ca/media/pdf/H0490_Search_Filters_for_Economic_Evaluations_mg_e.pdf
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Economic Evaluations (3)
Identifying studies reporting QALYs can be difficult
Different instruments used to measure QALYs
EQ-5D (EuroQol-5 Dimensions)
HUI (Health Utility Index)
SF-6D (Short Form 6 Dimensions)
Hard to find literature guidances about searching
What is the best approach?
Wisløff T1 , Hagen G1, Hamidi V1, Movik E1, Klemp M1, Olsen J.A.1, 2 1Norwegian Knowledge Centre for the Health Services, Oslo, Norway 2Institute of Community Medicine, University of Tromsø, Norway . QALYs in practice: A review of all published studies in 2010 that expressed health gains in terms of quality-adjusted-life-years. PharmacoEconomics in progress june 2013.
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4. Method guidances on searching
The Cochrane Handbook and CRD recommends:
NHS Economic Evaluation Database (NHS EED, free)
Health Economic Evaluations Database (HEED, subscription)
The Cost-Effectiveness Analysis Registry (CEA)
MEDLINE, Embase (General biomedical databases)
Cochrane Hanbook Version 5.1.0. Chapter 15 Incorporating economics evidence. Available from http://handbook.cochrane.org/ Centre for Reviews and Dissemination. Available from http://www.york.ac.uk/inst/crd/econ4.htm
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Method guidances (2)
Effectiveness studies can be filtered by search strategies designed to capture health economics studies
The NHS EED search strategies are broad - Narrower adaptations
Close reading of the scope notes of MeSH
Variations across databases in indexing or classification of health economics studies
Cochrane Hanbook Version 5.1.0. Chapter 15 Incorporating economics evidence. Available from http://handbook.cochrane.org/ Centre for Reviews and Dissemination. Available from http://www.york.ac.uk/inst/crd/econ4.htm
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http://www.crd.york.ac.uk/CRDWeb/HomePage.asp
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NHS Economic Evaluation Database (NHS EED)
5. Today's practice at NOKC
Sources we search to inform Economic Evaluations:
NHS Economic Evaluation Database (NHS EED)
(via CRD and Cochrane Library)
Embase/ MEDLINE using search filters
Reference lists (checked by health economists)
Handsearching HTA org. websites, etc.
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6. Core challenges identifying QALYs
Broad search filters – few terms for QALY measurements
Different coverage of subject headings in EMTREE/MeSH
There is a range of instruments to measure QALYs
Authors reports results insufficiently
Need to structure search strategies differently?
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EMTREE- EMBASE
”Cost-Effectiveness Analysis” as MeSH and EMTREE term
MeSH - MEDLINE
“Costs and Costs Analysis” as Broader Term
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MeSH (MEDLINE)
EMTREE (Embase)
“Quality of life” as MeSH and EMTREE term
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Embase: Broader term: Disease management
MEDLINE: Broader terms: Humanities > Life
Clinical Queries: “Economics”
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Ovid Clinical Queries: “Economics”
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http://hiru.mcmaster.ca/hiru/HIRU_Hedges_EMBASE_Strategies.aspx
Embase MEDLINE
7. Need for new search strategies?
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NHS EED - Search filter - Economic Evaluations
Broad MeSH terms 1. economics/ 2. exp "costs and cost analysis"/ 3. economics, dental/ 4. exp "economics, hospital"/ 5. economics, medical/ 6. economics, nursing/ 7. economics, pharmaceutical/
New search strategy identifying QALYs?
In a project about dialysis strategies for patients with kidney failure, relevant studies reporting QALYs were not identified
A new search approach combining
Adverse Event(s)/ Outcome(s) AND Quality of Life/ Instrument(s) identified two relevant studies included in the report
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Search approach 1
Disease Intervention Study design (Search filter)
Kidney failure Dialysis RCT, Economic evaluation, other
Search approach 2 for QALYs, “Quality of Life” or “Health Related Quality of Life”
(Adverse) Event/ Outcome - Not disease specific
Measurement/ Instrument
Sepsis (blood poisoning)
Quality of Life or HRQoL or EQ-5D (EuroQol-5 Dimensions) HUI (Health Utility Index) SF-6D (Short Form 6 Dimensions)
The projects objective: To compare efficacy, safety and cost-effectiveness of the different dialysis strategies for patients with end-stage kidney (renal) failure in Norway.
Note: Columns are combined with AND
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Search approach 1
Disease Intervention Study design (Search filter)
Osteoporosis Alendronate RCT, Economic evaluation, other
Search approach 2 for QALYs, “Quality of Life” or “Health Related Quality of Life”
(Adverse) Event/ Outcome - Not disease specific
Measurement/ Instrument
Hip fracture
Quality of Life or HRQoL or EQ-5D (EuroQol-5 Dimensions) HUI (Health Utility Index) SF-6D (Short Form 6 Dimensions)
The projects objective: Efficacy and cost-effectiveness of alendronate for the prevention of fractures in postmenopausal women in Norway.
Note: Columns are combined with AND
QALYs 1. quality-adjusted life years/ or "quality of life"/ 2. (quality adjusted life or qol).ti,ab. 3. (qaly$ or qald$ or qale$ or qtime$).ti,ab. 4. health$1 year$1 equivalent$1.ti,ab. 5. (hui or hui1 or hui2 or hui3).ti,ab. 6. (quality adj3 (wellbeing or well being)).ti,ab. 7. qwb.ti,ab. 8. (euro qual or euroqual).ti,ab. 9. or/1-8
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NHS EED - Search filter - QALY values
INSTRUMENTS 10. (sf36 or sf 36 or sf thirtysix or sf thirty six).ti,ab. 11. (sf6 or sf 6 or short form or shortform or sf six or sfsix).ti,ab. 12. (sf12 or sf 12 or sf twelve or sftwelve).ti,ab. 13. (sf16 or sf 16 or sf sixteen or sfsixteen).ti,ab. 14. (sf20 or sf 20 or sf twenty or sftwenty).ti,ab. 15. (euroqol or eq5d or eq 5d).ti,ab. 16. HUI or QWB or 15D or AQoL (NOKC adjusted) 17. or/10-16
8. Summary
Our experience is that searching for “Cost-effectiveness analysis” and “Quality of life” values is challenging
There might be differences in definitions of index terms and authors’ are often inconsistent in reporting methods
Discuss different search approaches with health economists
Questions to be further investigated:
Is a search strategy combining Adverse event(s)/ Outcome(s) AND “Quality of life”/ Instrument(s) an effective approach for identifying QALYs?
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Have you used this approach combining Adverse Event(s)/Outcome(s) and Quality of Life/Instrument(s) measuring QALYs ?
Do you use other approaches you would like to share with the audience?
What are the other challenges you face when conducting searches for health economic evaluations?
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Acknowledgements
Many thanks to Arna Desser, Gunhild Hagen, Espen Movik, Jan Abel Olsen, Vida Hamidi, Sari S. Ormstad, Julie Glanville and Steven Duffy for their vital contributions and guidances
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THANK YOU
감사합니다
Ingrid Harboe, Research Librarian
HTAi Seoul 2013
Pre-conference workshop
June 16
References
Alton V, Eckerlund I, Norlund, A 2006. Health economic evaluations: how to find them. Int J Technol Assess Health Care. 2006 Fall;22(4):512-7 Centre for Reviews and Dissemination http://www.york.ac.uk/inst/crd/econ4.htm Cochrane Hanbook Version 5.1.0. Chapter 15 Incorporating economics evidence. http://handbook.cochrane.org/ Glanville J, Fleetwood K, Yellowlees A, Kaunelis D, Mensinkai S. Development and Testing of Search Filters to Identify Economic Evaluations in MEDLINE and EMBASE. Ottawa: Canadian Agency for Drugs and Technologies in
Health; 2009. Available from: http://www.cadth.ca/media/pdf/H0490_Search_Filters_for_Economic_Evaluations_mg_e.pdf Glanville J, Paisley S. Identifying economic evaluations for health technology assessment. International journal of technology assessment in
health care 26, no. 4 (2010): 436-40. Glanville J, Paisley S. Searching for evidence on resource use, costs, effects and cost-effectiveness. IN: Shemilt I et al (eds). Evidence based
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Hagen G, Hamidi V, Movik E, Olsen JA, Wisløff T. Presented at Society for Medical Decision Making (SMDM), European meeting, Oslo 11.06.2012 . Poster 2012.
JAMAevidence.com, McGraw-Hill Global Education Holdings, LLC. Available from: http://www.jamaevidence.com/index
Royle P, Waugh N. Literature searching for clinical and cost-effectiveness studies used in health technology assessment reports carried out for the National Institute for Clinical Excellence appraisal system. Health Technology Assessment 2003;7(34). [page 32] [Ovid]
Sassi F et al. Searching Literature Databases for Health Care Economic Evaluations: How Systematic Can We Afford to Be? Medical Care, Issue: Volume 40(5), May 2002, pp 387-394.
Wisløff T1 , Hagen G1, Hamidi V1, Movik E1, Klemp M1, Olsen J.A.1, 2 1Norwegian Knowledge Centre for the Health Services, Oslo, Norway 2Institute of Community Medicine, University of Tromsø, Norway . QALYs in practice: A review of all published studies in 2010 that expressed health gains in terms of quality-adjusted-life-years. PharmacoEconomics; outline June 2013. http://adisonline.com/pharmacoeconomics/Documents/IFA%20PEC.pdf
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