Health economic evaluations based on routine data in Germany: a systematic review

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly...

BackgroundEpilepsy and other seizure disorders are medical conditions that impose a substantial health economic burden on society given their considerable costs of illness and use of healthcare resources. The ALVEEG trial aims to tackle resource shortages in clinical settings and optimize patient management by evaluating outpatient ambulatory long-term video electroencephalograms (ALVEEGs) as a new diagnostic pathway to diagnose and manage epilepsy and other seizure disorders. The health economic evaluation alongside this trial aims to determine the cost-effectiveness and cost-utility of ALVEEGs for affected patients presenting themselves at participating epilepsy centers in Germany.MethodsThis study protocol comprises the rationale and methods of the health economic evaluation of ALVEEGs embedded into the ALVEEG project. We will perform cost-effectiveness and cost-utility analyses, with the outcomes being a priori defined endpoint measures of the main trial. We will consider the proportion of solved clinical queries (primary endpoint), the number of hospital stays, the in-patient length of stay, and quality-adjusted life years for the here presented health economic evaluation. Costs will be collected by the participating health insurance companies alongside the trial, with the evaluation being conducted from a statutory health insurance perspective within the German healthcare system. The reporting of the economic evaluation follows the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.DiscussionThe health economic evaluation of ALVEEGs for patients affected by epilepsy and other seizure disorders within the German healthcare system will deliver insightful evidence on the cost-effectiveness and cost-utility of the intervention and hence guide policy and decision makers regarding a potential inclusion of ALVEEGs into the health benefit basket of the statutory health insurance scheme.Trial registrationGerman Clinical Trials Register (DRKS00032220), date registered: December 11, 2023.

Community pharmacists' scope of practice has been evolving from a traditional dispensing role to providing patient-centered services. Given the constraints in healthcare budget and a need for efficient use of finite resources, decision makers may require convincing evidence of value to recommend these services for public funding. Several economic evaluations have aimed to demonstrate the value of services provided by community pharmacists. The objective of this study was to systematically review the reporting and methodological quality of full economic evaluations of services provided by community pharmacists. A literature search was conducted in the bibliographic databases MEDLINE, EMBASE, and the NHS Economic Evaluations Database since their inception to February 2019. Two independent reviewers performed title, abstract, full text screening, and data abstraction and assessed the quality of reporting and methodological approaches using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Quality of Health Economic Studies (QHES) checklists. Twenty full economic evaluations were included in the review. Most of these studies were conducted in the UK (40%), followed by the USA (35%), Canada (10%), the Netherlands (5%), Thailand (5%), and Australia (5%). The efficacy or effectiveness data were drawn from individual level or cluster randomized trials, or observational studies. About half of these studies (45%) adopted the perspective of the public healthcare system. Four studies used decision analytic modeling. We identified issues in these studies with selection of study population, efficacy or effectiveness data, time horizon, outcomes measured, measurement or resources used and cost estimation, analytical approaches, and handling of uncertainty with study parameters. The quality of reporting and methodological considerations was variable across these studies, with none of the studies adequately fulfilling all 24 items of CHEERS or 16 questions of QHES checklists. Our findings suggest there are various issues related to the quality of conduct and reporting of economic evaluations of services provided by community pharmacists. Interpretation of these studies should be treated with caution to facilitate decision making in the local context. In an era of scarce resources and demand for evidence-informed decision making, there may be a need for guidance on methodological approaches to assess the value of these services.

Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.

Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc.). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer-reviewed journals, as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.

IntroductionThere has been a growing awareness of the need for rigorously and transparent reported health research, to ensure the reproducibility of studies by future researchers. Health economic evaluations, the comparative...

BackgroundDigital public health (DiPH) provides novel approaches for prevention, potentially leading to long-term health benefits in resource-limited health systems. However, cost-effectiveness of DiPH interventions is unclear. This systematized review investigates the use of decision-analytic modelling in health economic evaluations of DiPH primary prevention and health promotion interventions, focusing on intervention’s design, methods used, results, and reporting quality.MethodsPubMed, CINAHL, and Web of Science were searched for studies of decision-analytic economic evaluations of digital interventions in primary prevention or health promotion, published up to June 2022. Intervention characteristics and selected items were extracted based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Incremental cost-effectiveness ratios (ICERs) were then extracted and price-adjusted to compare the economic evaluation results. Finally, the included studies’ reporting quality was assessed by building a score using CHEERS.ResultsThe database search (including search update) produced 2,273 hits. After removing duplicates, 1,434 titles and abstracts were screened. Of the 89 studies meeting the full-text search criteria, 14 were ultimately reviewed. The most common targets were physical activity (five studies) and weight loss (four). Digital applications include text messages, web-based inventions, app-based interventions, e-learning devices, and the promotion of smartphone apps. The mean ICER of the 12 studies using quality-adjusted life years (QALYs) is €20,955 per QALY (min. − €3,949; max. €114,211). The mean of reported CHEERS items per study is 81% (min. 59%; max. 91%).ConclusionsThis review only includes primary prevention and health promotion, and thus excludes other DiPH fields (e.g. secondary prevention). It also focuses on decision-analytic models, excluding study-based economic evaluations. Standard methods of economic evaluation could be adapted more to the specifics of DiPH by measuring the effectiveness of more current technologies through alternative methods, incorporating a societal perspective, and more clearly defining comparators. Nevertheless, the review demonstrates using common thresholds that the new field of DiPH shows potential for cost-effective preventive interventions.

Because of a lack of suitable heart donors, alternatives to transplantation are required. These alternatives can have high costs. The aim of this study was to perform a systematic review of cost-effectiveness studies of ventricular assist devices (VADs) and to assess the level of evidence of relevant studies. The purpose was not to present economic findings. A systematic review was performed using four electronic databases to identify health economic evaluation studies dealing with VADs. The methodological quality and reporting quality of the studies was assessed using three different tools, the Drummond, Cooper, and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklists. Of the 1,258 publications identified, thirteen articles were included in this review. Twelve studies were cost-utility analyses and one was a cost-effectiveness analysis. According to the Cooper hierarchy scale, the quality of the data used was heterogeneous. The level of evidence used for clinical effect sizes, safety data, and baseline clinical data was of poor quality. In contrast, cost data were of high quality in most studies. Quality of reporting varied between studies, with an average score of 17.4 (range 15-19) according to the CHEERS checklist. The current study shows that the quality of clinical data used in economic evaluations of VADs is rather poor in general. This is a concern that deserves greater attention in the process of health technology assessment of medical devices.

ObjectivesThe objectives of this study were to review economic data on the use of closed system drug transfer devices (CSTDs) for preparing and administering hazardous drugs, and to evaluate the...

Aims To summarise evidence on economic evaluations (EEs) of primary caries prevention in preschool children aged 2-5 years and to evaluate the reporting quality of full EE studies using a quality assessment tool.Methods Systematic literature search from several databases. The reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.Results In total, 808 studies were identified and 39 were included in review. Complex multi-component interventions were the most common followed by water fluoridation. Cost analysis and cost-effectiveness were the most common EEs. Parameters that were not reported well were: characterising uncertainty, study perspective, sensitivity analysis and discount rate.Conclusions The number of EEs has increased but there is inconsistency in how EEs are conducted and reported.

<h3>Introduction</h3> Health authorities such as the FDA and NICE increasingly require new medical interventions to demonstrate quality-of-life improvements and cost-effectiveness through health economic assessments.^{1 2} However, these assessments often overlook patient preferences concerning which outcomes they value most.³ While the impact of hospitalisations on quality of life is well established,⁴ minor healthcare-related events—such as doctor visits, medication adjustments, and remote monitoring interactions—also contribute to patient burden.⁵ Emerging evidence indicates that frequent minor daily life disruptions can significantly affect well-being, yet they remain underrepresented in the health economic model.⁶ This feasibility study incorporates these considerations into a heart failure trial in the UK, aiming to refine the methodology and expand its scope in future research. The ultimate goal is to ensure that patient perspectives are meaningfully integrated into the evaluation of new interventions, thereby enhancing the relevance and applicability of QALY-based assessments. <h3>Methods</h3> A structured questionnaire, developed with input from patient representatives, was administered to heart failure patients over a six-month period to assess their willingness to trade life expectancy for improved health states. The questionnaire included two key scenarios: (1) trading current health for perfect health over a shorter lifespan and (2) trading lifespan to avoid specific health-related events, such as hospitalisations, doctor visits, blood tests, medication adjustments, and remote interactions. To minimise respondent burden, questions were randomly assigned, with a maximum of seven questions asked in months 1, 3, and 6. Responses were analysed to determine utility decrements associated with each event and their cumulative impact on QALYs. <h3>Results</h3> Preliminary data were collected from 70 heart failure patients enrolled in the HF-TRACK trial in the UK (NCT06334822). The average participant age was 76.7 years (standard deviation 12.9), with 47.4% female. The response rate was at least as high as that of the EQ-5D questionnaire, demonstrating participant engagement. Minor events such as weekly doctor visits, daily phone calls, and frequent medication changes had smaller per-event decrements compared to hospitalisations but accumulated significantly over time. Additionally, participants completed the EQ-5D questionnaire during the same period, allowing for direct comparison. The Time Trade-Off-derived utilities and existing QoL scores were broadly aligned, indicating consistency between the two methods. <h3>Conclusions</h3> This study demonstrates the feasibility of using TTO (Time Trade-Off) to assess the quality-of-life impact of both major and minor healthcare events in heart failure patients. The findings indicate that while hospitalisations have a substantial impact, frequent minor healthcare interactions also meaningfully contribute to patient burden. Incorporating these utility decrements into health economic models may enhance cost-effectiveness evaluations of interventions to reduce hospitalisations and optimise remote monitoring strategies. Future research should further validate these findings by cross-referencing results with established tools such as EQ-5D, KCCQ, and MLHFQ to provide a more comprehensive assessment of hospitalisation impact and healthcare interventions. <h3>References</h3> Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness—The curious resilience of the $50,000-per-QALY threshold. <i>N Engl J Med</i>. 2014;<b>371</b>(9):796–797. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. <i>Methods for the Economic Evaluation of Health Care Programmes</i>. Oxford University Press; 2015. Husereau D, Drummond M, Petrou S, <i>et al</i>. Consolidated health economic evaluation reporting standards (CHEERS)—Explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines task force. <i>Value in Health</i> 2013;<b>16</b>(2):231–250. Dobre D, de Jongste MJ, Haaijer-Ruskamp FM, van Veldhuisen DJ. The impact of hospitalization on health status and quality of life in heart failure patients. <i>Eur J Heart Fail</i>. 2008;<b>10</b>(7):708–713. Boyne JJ, Vrijhoef HJ, Spreeuwenberg MD, <i>et al</i>. Effects of telemonitoring on health status and quality of life in heart failure patients: a randomized controlled trial. <i>Eur J Cardiovasc Nurs</i>. 2014;<b>13</b>(3):242–249. Basu A, Meltzer D. Value of information on preference heterogeneity and individualized care. <i>Med Decis Making</i>. 2005;<b>25</b>(5):510–521.

BackgroundTransparency and clarity in reporting of methods used to identify, measure, and value outcomes and resources in published economic evaluations is crucial.ObjectiveThe aims of this review were to identify and assess the quality of published economic evaluation studies in the Gulf Cooperation Council (GCC) region, with a specific focus on methods used to identify, measure, and value cost and outcomes data.MethodsAn electronic search of publications from 2009 to October 2019 was performed in three clinical (Medline, Scopus, and EMBASE) and one economic (NHS EED) databases. Full economic evaluations undertaken in GCC countries from any perspective were included. Reference lists of three reviews on the same topic and area were also searched for further eligible articles. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used for methodological quality assessment. Data on type and source of cost and outcomes data were collected.ResultsOut of 1857 studies identified, 14 relevant studies were eligible and included. Eleven studies were based in Saudi Arabia, and the remaining studies were published in the United Arab of Emirates (UAE), Qatar, and Oman. Majority of the evaluations were based on the Markov modelling (n=8). None of the studies fully fulfilled the CHEERS quality criteria. Quality-adjusted life years (QALYs) was the main outcome (n=10). The EQ-5D was valued using the UK value set tariff (n=6). Published literature was the source of outcomes data in seven studies. Hospital-based data were used as a source of healthcare resource use data in four studies, whereas hospital-based costs (n = 7) combined with other sources such as local/national data were the sources of unit cost data in the majority of the studies.ConclusionRigorous economic evaluations are lacking in the region leading to inaccurate information being given to decision-makers.

The increasing number of treatment options and the high costs associated with epilepsy have fostered the development of economic evaluations in epilepsy. It is important to examine the availability and quality of these economic evaluations and to identify potential research gaps. As well as looking at both pharmacologic (antiepileptic drugs [AEDs]) and nonpharmacologic (e.g., epilepsy surgery, ketogenic diet, vagus nerve stimulation) therapies, this review examines the methodologic quality of the full economic evaluations included. Literature search was performed in MEDLINE, EMBASE, NHS Economic Evaluation Database (NHS EED), Econlit, Web of Science, and CEA Registry. In addition, Cochrane Reviews, Cochrane DARE and Cochrane Health Technology Assessment Databases were used. To identify relevant studies, predefined clinical search strategies were combined with a search filter designed to identify health economic studies. Specific search strategies were devised for the following topics: (1) AEDs, (2) patients with cognitive deficits, (3) elderly patients, (4) epilepsy surgery, (5) ketogenic diet, (6) vagus nerve stimulation, and (7) treatment of (non)convulsive status epilepticus. A total of 40 publications were included in this review, 29 (73%) of which were articles about pharmacologic interventions. Mean quality score of all articles on the Consensus Health Economic Criteria (CHEC)-extended was 81.8%, the lowest quality score being 21.05%, whereas five studies had a score of 100%. Looking at the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), the average quality score was 77.0%, the lowest being 22.7%, and four studies rated as 100%. There was a substantial difference in methodology in all included articles, which hampered the attempt to combine information meaningfully. Overall, the methodologic quality was acceptable; however, some studies performed significantly worse than others. The heterogeneity between the studies stresses the need to define a reference case (e.g., how should an economic evaluation within epilepsy be performed) and to derive consensus on what constitutes "standard optimal care."

Impact of Fatty Liver Disease on Health Care Utilization and Costs in a General Population: A 5-Year Observation