Simple but not simpler: a systematic review of Markov models for economic evaluation of cervical cancer screening

The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical cancer screening strategies. Two independent reviewers screened articles for relevance and performed data extraction. Methodological assessment of the quality of the models utilized formal checklists, and a qualitative narrative synthesis was performed. Thirty-eight articles were reviewed. The majority of the studies were conducted in high-income countries (82%, n=31). The Pap test was the most used screening strategy investigated, which was present in 86% (n=33) of the studies. Half of the studies (n=19) used a previously published Markov model. The deterministic sensitivity analysis was performed in 92% (n=35) of the studies. The mean number of properly reported checklist items was 9 out of the maximum possible 18. Items that were better reported included the statement of decision problem, the description of the strategies/comparators, the statement of time horizon, and information regarding the disease states. Compliance with some items of the checklist was poor. The Markov models for economic evaluation of screening strategies for cervical cancer varied in quality. The following points require improvement: 1) assessment of methodological, structural, heterogeneity, and parameter uncertainties; 2) model type and cycle length justification; 3) methods to account for heterogeneity; and 4) report of consistency evaluation (through calibration and validation methods).

Evaluación de la calidad metodológica de la literatura en evaluación económica en salud en Colombia: una revisión sistemática / Quality assessment of economic evaluations in health care in Colombia: a systematic review

Introducción. La evaluación económica es una herramienta que contribuye a establecer prioridades en la toma de decisiones en salud. La calidad metodológica de los estudios realizados en Colombia no se ha evaluado de manera sistemática. Objetivo. Valorar la calidad metodológica de las evaluaciones económicas en salud publicadas en Colombia. Materiales y métodos. Se llevó a cabo una revisión sistemática de evaluaciones económicas completas (costos y efectividad de, al menos, dos programas o servicios de salud) referidas a un problema de decisión en salud de Colombia. La búsqueda se hizo en bases de datos internacionales y colombianas, y se complementó con búsqueda manual y consulta con autores. La síntesis de los datos se hizo en tablas que incluían información relevante sobre los estudios, y la calidad metodológica se evaluó con un instrumento prediseñado. Las búsquedas se hicieron entre enero y febrero de 2012. Resultados. Se incluyeron 48 estudios. En la mayoría de los estudios se hace explícito el punto de vista, se describen las alternativas comparadas y se hace un análisis incremental (sic.). Más de la mitad de los trabajos presentan limitaciones en la especificación del horizonte temporal o la tasa de descuento, en la estimación y actualización de los beneficios en salud y los costos, así como en la consideración de cuestiones de equidad o implementación. El análisis de la incertidumbre resulta ser el punto más problemático. Conclusiones. Las evaluaciones económicas en salud publicadas en Colombia han aumentado en los últimos años; sin embargo, se observa una gran heterogeneidad en los métodos, lo cual dificulta la comparación de los resultados y su uso para la toma de decisiones en salud. Es fundamental avanzar en la estandarización de los métodos, con el fin de contribuir a generar información de mejor calidad que permita apoyar las decisiones en el sistema de salud colombiano.

Introduction: Economic evaluation is a tool that can provide useful information to decision-makers in health. The methodological quality of Colombian studies has not been assessed in a systematic way. Objective: To assess the methodological quality of economic evaluations in health care in Colombia. Materials and methods: Systematic review of economic studies that assessed both costs and effectiveness of at least two technologies related to a decision problem in Colombia. Search was performed in international and Colombian databases and was completed with manual searches and contact with authors. Data was synthesized in tables that included relevant information about the studies. Methodological quality was evaluated using a predefined instrument. Searches were performed between January and February. Results: 48 studies were included in the review. Perspective of the study, incremental analyzes and description of alternatives were usually well specified. However, more than half of the articles did not state clearly the time horizon or discount rate and most studies did not address equity and implementation issues. Management of uncertainty was also problematic. Conclusions: Economic evaluation in health care in Colombia has grown considerably in recent years. However, methods vary considerably between studies and therefore their usefulness for decisionmaking in health is limited. It is necessary to standardize methods in order to generate evidence of higher quality to support decisions within the Colombian health care system.

Propuesta de reglas de decisión en las evaluaciones económicas de tecnologías sanitarias para el contexto cubano / Proposals of decision rules in economic assessment of health technologies for the Cuban context

INTRODUCCIÓN: Aunque las evaluaciones económicas en el sector sanitario cubano han crecido en número y en calidad, con poca periodicidad son utilizadas en la toma de decisiones, ni se solicitan con frecuencia. Una de las posibles causas para no emplearlas es que casi ninguna muestra las reglas de decisión aplicadas por los investigadores para la alternativa que proponen, lo que incrementa la incertidumbre de los encargados de tomar decisiones. OBJETIVO: Presentar un grupo de reglas de decisión en evaluaciones económicas que forman parte de la literatura. RESULTADOS: Se presentan criterios de decisión para evaluaciones económicas de tipo costo efectividad (plano costo efectividad); costo utilidad (considerada una variante de la técnica costo efectividad) emplea como criterio de decisión el plano costo efectividad también; costo beneficio utiliza el valor actual neto, la razón costo beneficio bruta y la tasa interna de rendimiento. CONCLUSIÓN: La aplicación de reglas de decisión en las evaluaciones económicas contribuye a la reducción de la incertidumbre en el momento de decidir entre alternativas

INTRODUCTION: Although the economic assessments in the Cuban health sector have increased in number and in quality, they are neither used frequently used in the decision-making nor are frequently requested. One of the potential causes of this non-use is that almost any shows of decision rules applied by researchers for the own alternative increasing the uncertainty of those charged of decisions-making. OBJECTIVE: To present a series of decision rules in economic assessments to be part of the literature. RESULTS: Some decision criteria are presented for economic assessment of cost-effectiveness ( cost-effectiveness plan); cost-usefulness (a variant of cost-effectiveness technique) which uses as decision criterion also the cost-effectiveness plan; cost-benefit uses the net current value, the gross cost-benefit ratio and the performance internal rate. CONCLUSION: The researches related to economic evaluations must to be enclosed by the decision rules on the proposed alternatives, thus it allow to decision-maker to make the choice

Revisitando a literatura sobre custo-efetividade e utilidade em saúde / Reviewing the literature of cost-effectiveness and cost-utility analysis in health

Este trabalho tem por finalidade contribuir com a disseminação do conteúdo teórico desta área do conhecimento, assim como oferecer subsídios para reflexões no que tange à consecução de estudos, os quais resultem em reais benefícios para a população e a gestão do sistema de saúde. Para tanto se realizou, sob uma perspectiva histórica e com base no ponto de vista de reconhecidos autores, ampla revisão da literatura que abrangeu desde sua fundamentação teórica até a formalização de guias metodológicos. O estudo ressalta, inclusive, as controvérsias metodológicas conseqüentes da diversidade das abordagens teóricas. E, como decorrência, recomenda a realização de pesquisas sobre a fundamentação teórica, particularmente a abordada pelos extrawelfaristas.

This study aims to contribute to the dissemination of the theoretical foundations for cost-effectiveness and cost-utility analysis. It also provides backing for reflections on the implementation of studies leading to real benefits for both the population and health system management. Taking a historical perspective, and drawing on the work of renowned authors, the study provides an extensive literature review on cost-effectiveness and cost-utility analysis, from the theoretical formulation to the definition of methodological guidelines. The study also highlights the methodological controversies resulting from the diversity of theoretical approaches. As a result, it recommends conducting research on the theoretical foundations, and particularly the position of the extra-welfarists.

Cost benefit of the routine urinalysis

In the present health care environment, cost-benefit analysis is extremely important. In this screening program, the minimal cost of screening dipstick urinalysis in 1601 asymptomatic school children was determined. The process of screening was similar to all the studies. The minimal cost utilizing 3 general physicians was calculated. Costs were determined by using current charge for supplies ordered to perform tests, charges for tests performed by a commercial laboratory, and the cost of a final evaluation by a pediatric nephrologist. Initial abnormal urinalysis was found in 4.7% [76/1601] of patients. Upon retesting 1.37% [22/1601] of patients were calculated to have a persistent abnormality. The calculated cost was 1/530/000 Rials [164.5 $] to initially screen all 1601 patients with a dipstick urinalysis or 850 Rials [0.09 $] per patient. The calculated cost to evaluate the 22 patients with any persistent abnormality on repeat dipstick urinalysis was 246/840 Rials [26.5 $] or 11.220 Rials [1.2 $] per patient. This is the calculated cost for a single screening of 1601 asymptomatic pediatric patients. Multiple screening dipstick urinalysis in asymptomatic pediatric are costly and should be discontinued. We purpose that a single screening dipstick urinalysis be obtained at school entry age, between 6 and 7 years old, in all asymptomatic children

Evaluación economica de la aplicación de una escala validada para el diagnostico de la enfermedad por reflujo gastroesofagico / Economic validation study of the aplication of a falidated scale for the diagnosis of the gastroesophageal reflux disease

1.Pregunta de investigación: ¿Puede la aplicación de una escala presentar ventajas comparativas económicas a la palicación de los métodos completamente habituales en el diagnóstico y seguimiento de los pacientes con enfermedad por reflujo gastroesofágico (ERGE)? 2. Objetivos: Realizar una evauación teórica de los costos implicados al aplicar la escala en el diagnostico de la ERGE. 3. Diseño: Estudio de evaluación económica de costo-efectividad. 4. Lugar: Hospital de Clinicas de La Paz, Bolivia. 5.Analisis propuestos: Análisis de costos directos, indirectos e intangibles. Arbol de decisiones económicas. Resultados:El uso de la escala es altamente favorable en términos económicos. 7. conclusiones: Unida a sus efectividad diagnostica, la eficacia económia convierte a la escala en un istrumento atractivo para usarse en la practica clínica.