Critical Appraisal of Economic Evaluation Literature (Video)

Vocabulary flashcards covering key terms and concepts from the lecture on Critical Appraisal of Economic Evaluation Literature.

Economic evaluation

A comparative analysis of the costs and consequences associated with competing interventions.

Cost-effectiveness analysis (CEA)

An economic evaluation comparing relative costs and health outcomes, typically using natural units (e.g., life-years gained).

Cost-benefit analysis (CBA)

An economic evaluation that monetizes costs and benefits to determine whether benefits exceed costs.

Cost-consequences analysis (CCA)

An analysis that presents costs and multiple health outcomes separately without aggregating them into a single metric.

Cost-utility analysis (CUA)

A CEA where outcomes are measured in utility-weighted units, such as QALYs.

Cost-minimization analysis (CMA)

Used when outcomes are assumed to be equivalent; focuses on identifying the cheapest option.

Stages of an economic evaluation

Seven steps: clarify the study question; identify, quantify, and value costs and consequences; analyze; interpret; and inform decision makers.

Clarification of the study question

Defining the research question to be answered by the evaluation.

Identification of all possible resource and health consequences

Listing all relevant costs and health outcomes for the decision.

Quantification of important resource and health consequences

Measuring the magnitude of costs and outcomes.

Valuation of quantified resource and health consequences

Assigning monetary values or weights to quantified items.

Analysis

Processing data to estimate totals, differences, and relationships among costs and outcomes.

Interpretation of the results

Explaining what the results mean for decision makers and policy.

Use of the results by the decision maker

How the findings inform policy, funding, or program choices.

Critical appraisal

Systematically assessing the trustworthiness, relevance, and results of published papers.

Drummond checklist

A widely used checklist for critically appraising economic evaluation literature (10 items).

Well-defined question (Drummond item 1)

A clearly stated, answerable research question.

Comprehensive description of competing alternatives (Drummond item 2)

Inclusion of all important alternative options in the analysis.

Effectiveness established (Drummond item 3)

Demonstrated that the program or service works in real-world settings.

Important costs and consequences identified (Drummond item 4)

All relevant costs and outcomes for each alternative are listed.

Costs measured in appropriate physical units (Drummond item 5)

Costs are quantified using suitable units (e.g., dollars, hours, events) before valuation.

Costs valued credibly (Drummond item 6)

Costs and consequences are given credible monetary or descriptive values.

Discounting (Drummond item 7)

Adjusting future costs and benefits to present values to account for time preference.

Incremental analysis (Drummond item 8)

Comparison of incremental costs and incremental effects between alternatives.

Uncertainty characterized (Drummond item 9)

Assessing how uncertainty affects results, often with sensitivity analyses.

Presentation for users (Drummond item 10)

Discussing results with regard to issues important to decision makers and users.

Perspective (in economic evaluation)

The viewpoint from which costs and consequences are considered.

Societal perspective

All costs and outcomes to whomsoever they accrue, across society.

Government perspective

Costs and outcomes to the public sector (health, housing, legal, etc.).

Health sector perspective

Costs and outcomes for government and private health care providers and payers.

Payer perspective

Costs and outcomes for payers (insurers, funders, donors).

Patients perspective

Out-of-pocket costs, travel, waiting time, and other patient costs.

Time horizon

The period over which costs and outcomes are measured; should be appropriate to the question.

Comparator

The alternative(s) against which the new intervention is evaluated; may include a do-nothing option.

Do-nothing alternative

A comparator representing no intervention or standard care, used for comparison.

Randomised controlled trial (RCT)

A study design that randomizes participants to treatments to establish efficacy under ideal conditions.

Efficacy vs effectiveness

Efficacy: how well an intervention works in ideal conditions; effectiveness: how it performs in regular practice.

Subgroups adequately defined

Specifying relevant patient subgroups for separate analysis.

Discount rate

The rate used to discount future costs and benefits to present value.

Incremental cost

Additional cost of one option over another.

QALY (Quality-Adjusted Life Year)

A measure combining length and quality of life to assess health gains.

ICER (Incremental Cost-Effectiveness Ratio)

The ratio of incremental cost to incremental effect between two alternatives.

Cost-effectiveness threshold

The maximum acceptable cost per unit of health gain (e.g., per QALY) used by decision makers.

CEAC (Cost-Effectiveness Acceptability Curve)

Curve showing the probability that an intervention is cost-effective at different thresholds.

Sensitivity analysis

Exploring how results change when key assumptions or inputs vary.

One-way sensitivity analysis

Varying one parameter at a time to assess impact on results.

Heterogeneity

Variability in results across different subgroups of patients.

Generalisability / Translatability

Extent to which results apply to other settings or contexts.

Present value

Current worth of future costs or benefits after applying discounting.