Health Economics and

Systematic Review

Son Nghiem

HEALTH ECONOMICS

What is health economics?

A branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the

production and consumption of health and health care

Health Economics

Experimental studies

Epidemiology

Decision theory Cost analysis

Econometrics

Adapted from G. Baio (2013) Bayesian Methods in Health Economics

What do health economists do?

• Analyze the efficiency and equity in health care financing

• Identify determinants of health care demand• Estimate and predict of trends in health care costs• Determine the labor market in health care• Analyzing the budget system and inventory

management

Health care

EconomicsHealth Economics

What is a Systematic Review?

A review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review.

Cochrane Collaboration (2005) Glossary of Terms in The Cochrane Collaboration

Systematic vs Traditional Review

Question Scoping search Full search

Title and abstract

screening

Full text screening

Additional searching

Included references

agreed

Data extraction

Synthesis

Writing up

Reference management

Protocol

Update search

Full text retrieval

Systematic review process

Publication

Review Team

• Clinical expert – Initiates, defines, selects topic.– Partners in above process, and collaborates in review to prevent bias.

• Statistician– Provides methodological oversight, ensures process quality for entire

project.• Librarian

– Provides methodological oversight, ensues process quality for information search process.

• Healthcare consumer– Provides insight into the priorities for research, information conduit for

relating priorities and findings between consumers and clinicians.

Research Questions

Example Research Question

Are antiseptic washes more effective than non-antiseptic washes at preventing nosocomial infections in patients undergoing surgery?

intervention comparison

outcome population

Mind map research question

Research question

1st theme

4th theme

3rd theme

2nd

theme

synonym

synonym

synonym

synonym

synonym

synonym

synonym

synonym

synonym

synonym synonym

synonym

Construct search phrases

1st theme   OR   OR   OR

AND

2nd theme   OR   OR   OR

AND

3rd theme   OR   OR   OR

AND

4th theme?   OR   OR   OR

Example search phrase(cost benefit* or cost effectiveness or economic*) AND (disability insurance[Title/Abstract] OR national health[Title/Abstract] OR health insurance[Title/Abstract]) NOT (drug* or obesity or diabetes or cancer or heart or wound* or disease or illness)

Identifying sources• Databases?

Cochrane, NHS EED, HTA, DARE, Bibliomap• Websites?

Google? Search by Organisation• Hand searching?

Which journals are key to your work? • Snowballing?

WoK or Scopus• Books?

LibrarySearch or COPAC or GoogleBooks• Grey literature?

Google: blog search; SIGLE; conference proceedings

• Ongoing trials?Trials registers

Reference management

Software Database connectivity

Import format Word processor integration PDF

Organization

BibDesk Good Excellent Lyx GoodEndNote Excellent Good MS Word, OpenOffice, Pages N/AJabRef Good Excellent OpenOffice, MS Word, Lyx N/AKBibTeX Excellent Fair Lyx ?Mendeley Excellent Fair MS Word, OpenOffice ExcellentPapers Excellent Poor MS Word, OpenOffice, Pages FairQiqqa Fair Fair MS Word, Lyx ExcellentDocear Poor Good MS Word, Pages, TexEdit, Lyx ExcellentZotero Good Good MS Word, OpenOffice, GoogleDocs Good

META-ANALYSIS

• The analysis of other analyses• Uses data from randomized controlled trials• Aggregates and combines the results of

comparable studies into a coherent account to discover main effects

• Often uses statistical processes• Looks at effect size, not only statistical

significance• Combines the results of small-scale studies• Uses transparent means to draw conclusions

Meta-analysis

Synthesis: complete pooling

𝑦 11 , 𝑦1 2 ,… , 𝑦1𝑛 𝑦 21 , 𝑦 22 ,…, 𝑦2𝑛 𝑦 𝑛1, 𝑦 𝑛2 ,…, 𝑦𝑛𝑛

Study 1 Study 2 Study n

G. Baio (2013) Bayesian Methods in Health Economics

Synthesis: No pooling

1

𝑦 11 , 𝑦1 2 ,… , 𝑦1𝑛 𝑦 21 , 𝑦 22 ,…, 𝑦2𝑛 𝑦 𝑛1, 𝑦 𝑛2 ,…, 𝑦𝑛𝑛

Study 1 Study 2 Study n

2 n

G. Baio (2013) Bayesian Methods in Health Economics

Synthesis: mixed

𝑦 11 , 𝑦1 2 ,… , 𝑦1𝑛 𝑦 21 , 𝑦 22 ,…, 𝑦2𝑛 𝑦 𝑛1, 𝑦 𝑛2 ,…, 𝑦𝑛𝑛

Study 1 Study 2 Study n

1 2 n

G. Baio (2013) Bayesian Methods in Health Economics

Bias in meta-analysisPublication bias:

Studies never published

Studies with no beneficial effect of treatment

Studies sponsored by pharmaceutical industry

Studies from a single centre versus multiple centers

Language bias:

Positive findings published in a international journal

Negative findings published in a local journal

Database bias:

Journals not indexed in major databases

“Doing a meta-analysis is easy, doing one well is hard”Ingram Olkin