Academic journal article Applied Health Economics and Health Policy

What Is the Quality of Economic Evaluations of Non-Drug Therapies? A Systematic Review and Critical Appraisal of Economic Evaluations of Radiotherapy for Cancer

Academic journal article Applied Health Economics and Health Policy

What Is the Quality of Economic Evaluations of Non-Drug Therapies? A Systematic Review and Critical Appraisal of Economic Evaluations of Radiotherapy for Cancer

Article excerpt

Abstract

Background Breast, cervical and colorectal cancers are the three most frequent cancers in women, while lung, prostate and colorectal cancers are the most frequent in men. Much attention has been given to the economic evaluation of pharmaceuticals for treatment of cancer by the National Institute for Health and Care Excellence (NICE) in the UK and similar authorities internationally, while economic analysis developed for other types of anticancer interventions, including radiotherapy and surgery, are less common.

Objectives Our objective was to review methods used in published cost-effectiveness studies evaluating radiotherapy for breast, cervical, colorectal, head and neck and prostate cancer, and to compare the economic evaluation methods applied with those defined in the guidelines used by the NICE technology appraisal programme.

Methods A systematic search of seven databases (MEDLINE, EMBASE, CDSR, NHSEED, HTA, DARE, Econ- Lit) as well as research registers, the NICE website and conference proceedings was conducted in July 2012. Only economic evaluations of radiotherapy interventions in individuals diagnosed with cancer that included qualityadjusted life-years (QALYs) or life-years (LYs) were included. Included studies were appraised on the basis of satisfying essential, preferred and UK-specific methods requirements, building on the NICE Reference Case for economic evaluations and on other methods guidelines.

Results A total of 29 studies satisfied the inclusion criteria (breast 14, colorectal 2, prostate 10, cervical 0, head and neck 3). Only two studies were conducted in the UK (13 in the USA). Among essential methods criteria, the main issue was that only three (10 %) of the studies used clinical-effectiveness estimates identified through systematic review of the literature. Similarly, only eight (28 %) studies sourced health-related quality-of-life data directly from patients with the condition of interest. Other essential criteria (e.g. clear description of comparators, patient group indication and appropriate time horizon) were generally fulfilled, while most of the UK-specific requirements were not met.

Conclusion Based on this review there is a dearth of upto- date, robust evidence on the cost effectiveness of radiotherapy in cancer suitable to support decision making in the UK. Studies selected did not fully satisfy essential method standards currently recommended by NICE.

1 Introduction

Economic evaluations are increasingly used to inform decisions about the efficient allocation of healthcare resources. To date, these methods have mainly been applied to evaluate pharmaceutical interventions. Less evidence is available for other types of intervention, such as medical devices, surgical techniques and public health interventions, and decision making in these cases appears more challenging [1, 2]. The National Institute for Health and Care Excellence (NICE) in the UK represents an independent organisation tasked with assessing the clinical and cost effectiveness of health technologies and, to date, has mainly focused on new pharmaceutical and biopharmaceutical products. However, the scope of their responsibilities continues to expand and now includes diagnostics, public health interventions and social care.

NICE has issued a Reference Case for cost effectiveness in technnology appraisal, which specifies the methods standards considered to be consistent with a UK National Health Service (NHS) objective of improving population health given limited resources and a fixed budget. An element that distinguishes NICE from most other agencies is the explicit statement of a cost-effectiveness threshold, in terms of cost per quality-adjusted life-year (QALY) gained (£20,000-30,000), to classify interventions as good value for money.

Cancer is a leading cause of morbidity and mortality worldwide. An estimated 12.7 million new cases of cancer were diagnosed worldwide in 2008, with 7. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.