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APPENDIX 11:
SEARCH STRATEGIES FOR THE IDENTIFICATION
OF HEALTH ECONOMICS EVIDENCE
Search strategies for the identification of health economics and quality-of-life studies.
1 General search filters (see Appendix 8)
2 Health economics and quality-of-life search filters
MEDLINE, EMBASE, PsycINFO, CINAHL – OVID INTERFACE
1 exp “costs and cost analysis”/or “health care costs”/
2 exp health resource allocation/or exp health resource utilization/
3 exp economics/or exp economic aspect/or exp health economics/
4 exp value of life/
5 (burden adj5 (disease or illness)).tw.
6 (cost$ or economic$ or expenditure$ or price$1 or pricing or pharmacoeco-
nomic$).tw.
7 (budget$ or fiscal or funding or financial or finance$).tw.
8 (resource adj5 (allocation$ or utilit$)).tw.
9 or/1–8
10 (value adj5 money).tw.
11 exp quality of life/
12 (quality$ adj5 (life or survival)).tw.
13 (health status or QOL or well being or wellbeing).tw.
14 or/9–13
Details of additional searches undertaken to support the development of this
guideline are available on request.
Appendix 11
459
Appendix 12
460
APPENDIX 12:
QUALITY CHECKLIST FOR FULL ECONOMIC
EVALUATIONS
Author: Date:
Title:
Study design Ye s N o N A
1 The research question is stated
2 The viewpoint(s) of the analysis are clearly stated
3 The alternatives being compared are relevant
4 The rationale for choosing the alternative programmes
or interventions compared is stated
5 The alternatives being compared are clearly described
6 The form of economic evaluation used is justified
in relation to the question addressed
Data collection
1 The source of effectiveness data used is stated
2 Details of the design and results of the effectiveness
study are given
3 The primary outcome measure(s) for the economic
evaluation are clearly stated
4 Methods to value health states and other benefits
are stated
5 Details of the subjects from whom valuations were
obtained are given
6 Indirect costs (if included) are reported separately
7 Quantities of resources are reported separately from
their unit costs
8 Methods for the estimation of quantities and unit costs
are described
9 Currency and price data are recorded
10 Details of currency of price adjustments for inflation
or currency conversion are given
11 Details of any models used are given
12 The choice of model used and the key parameters on
which it is based are justified
Analysis and interpretation of results
1 Time horizon of costs and benefits is stated
2 The discount rate(s) is stated
3 The choice of rate(s) is justified
4 An explanation is given if costs or benefits are
not discounted
5 Details of statistical tests and confidence intervals are
given for stochastic data
6 The approach to sensitivity analysis is given
7 The choice of variables for sensitivity analysis is given
8 The ranges over which the variables are varied are stated
9 Relevant alternatives are compared
10 Incremental analysis is reported
11 Major outcomes are presented in a disaggregated
as well as aggregated form
12 The answer to the study question is given
13 Conclusions follow from the data reported
14 Conclusions are accompanied by the appropriate caveats
Appendix 12
461
Appendix 13
462
APPENDIX 13:
DATA EXTRACTION FORM FOR
ECONOMIC STUDIES
Reviewer: Date of Review:
Authors:
Publication Date:
Title:
Country:
Language:
Economic study design:
CEA CCA
CBA CA
CUA
CMA
Modelling:
No Ye s
Source of data for effect size measure(s):
Meta-analysis
RCT
Quasi experimental study
Cohort study
Mirror image (before-after) study
Expert opinion
Comments:
Primary outcome measure(s) (please list):
Interventions compared (please describe):
Treatment:
Comparator:
Setting (please describe):
Patient population characteristics (please describe):
Perspective of analysis:
Societal Other: _________________________
Patient and family
Healthcare system
Healthcare provider
Third-party payer
Time frame of analysis: _______________________________________________
Cost data:
Primary Secondary
If secondary please specify: _____________________________________________
Costs included:
Direct medical Direct non-medical Lost productivity
direct treatment social care income forgone due
inpatient social benefits to illness
outpatient travel costs income forgone due to
day care caregiver death
community health care out-of-pocket income forgone by
medication criminal justice caregiver
training of staff
Or
staff
medication
Appendix 13
463
Appendix 13
464
consumables
overhead
capital equipment
real estate Others:
Currency: Year of costing:
Was discounting used?
Yes, for benefits and costs Yes, but only for costs No
Discount rate used for costs:
Discount rate used for benefits:
Result(s):
Comments, limitations of the study:
Quality checklist score (Yes/NA/All): . . .. ../. . . . . ./. . . . . .
APPENDIX 14:
EVIDENCE TABLES FOR ECONOMIC STUDIES
Appendix 14
465
466
Donnelly
et al., 2004
Australia
Interventions:
Methylphenidate
Dexamfetamine
Comparator:
Standard practice
(contact with
health services
but no
medication)
Australian children
aged 4–17 years
who seek care for
ADHD in 2000
but do not receive
stimulants
(N 21,000)
Decision-analytic
modelling
Source of clinical
effectiveness data:
meta-analysis of
RCTs
Source of resource
use and measure of
severity of ADHD:
National Survey of
Mental Health and
Wellbeing
Source of unit costs:
national sources
Cost-utility
analysis
Methylphenidate
versus standard
practice: $15,000/
DALY saved (95%
CI: $9,100 to
$22,000)
Dexamfetamine
versus standard
practice: $4,100/
DALY saved (95%
CI: Dexamfetamine
dominant to
$14,000)
Dexamfetamine
dominated
methylphenidate
(equally effective
but cheaper)
Costs: healthcare costs
● Drug acquisition costs
● Healthcare
professional contacts
(GPs, paediatricians,
psychiatrists)
Mean incremental cost
versus standard practice
(N 21,000):
Methylphenidate: $1.7million
Dexamfetamine: $7million
Primary outcome: DALYs
averted
Mean % of years lived with
disability avoided with
intervention versus standard
practice (N 21,000):
Methylphenidate: 25
Dexamfetamine: 23
Perspective: health-
care sector (overall
government and
patient)
Currency: Aus $
Cost year: 2000
DALYs
generated using
previously published
disability weights
and the ‘survey
severity method’
Time horizon: 1 year
Discounting: not
needed
Internal validity:
25/4/6
Study Intervention Study population Study type Costs: description and values Results: Comments
and country details Study design Outcomes: description Cost Internal validity
Data sources and values effectiveness (Yes/No/NA)
467
Gilmore &
Milne, 2001
UK
King et al.,
2006
UK
Intervention:
Methylphenidate
Comparator: No
treatment
(placebo)
Interventions:
Methylphenidate-
IR
Methylphenidate-
MR-8 hours
Methylphenidate-
MR-12 hours
Atomoxetine
Dexamfetamine
Plus all the above
Children aged 6–12
years with
hyperkinetic
disorder
Decision-analytic
modelling
Source of clinical
effectiveness data:
literature review
Resource use
estimates: expert
opinion
Source of unit
costs: national
sources and local
trust tariffs
Children aged 6
years with ADHD
Decision-analytic
modelling
Source of clinical
effectiveness
data: systematic
literature review
Cost-utility
analysis
Cost-utility
analysis
Methylphenidate
versus placebo:
£9,177/QALY
Range of ICER in
sensitivity analysis:
from £5,782 to
£29,049/QALY
Analysis including
sequences of
medication alone
plus no treatment:
Dexamfetamine-
[methylphenidate-
IR]-atomoxetine
was dominant
(remained in most
scenarios explored)
Costs: healthcare costs
● Drug acquisition costs
● Outpatient clinic costs
Mean cost per 100 children:
Methylphenidate: £51,930
Placebo: 0
Primary outcome: QALYs
Mean QALYs per 100
children:
Methylphenidate: 94.06
Placebo: 88.4
Costs: healthcare costs
● Drug acquisition costs
● Healthcare professional
contacts (psychiatrists,
paediatricians, GPs)
● Laboratory testing
Mean cost per child:
Active treatment sequences:
ranging from £1,098
Perspective: NHS
Currency: UK £
Cost year: 1997
QALYs generated
using the IHRQL
Time horizon: 1 year
Discounting: not
needed
Internal validity:
28/1/6
Perspective: NHS
and Personal
Social Services
Currency: UK £
Cost year: 2003
QALYs based on
EQ-5D questionnaires
(Coghill et al., 2004)
Time horizon: 1 year
(secondary analysis:
Continued
468
medications
combined with
behavioural
therapy
Comparator: No
treatment
(placebo)
Strategies
assessed: 37
strategies in total,
consisting of 18
possible sequences
of three active
treatments, 18
respective
sequences of
combination thera-
pies, plus no
treatment
and meta-analysis;
mixed treatment
comparison model
Source of resource
use estimates:
expert opinion
Source of unit costs:
national sources
Probabilistic
analysis:
Dexamfetamine-
[methylphenidate-
IR]-atomoxetine
most likely cost-
effective option for
WTP between 0
and £60,000/QALY
Sub-analysis
including
combination
strategies: all
therapies except two
were ruled out by
dominance; of the
two remaining:
Combination
(dexamfetamine-
atomoxetine-
[methylphenidate-
MR-8 hours]) versus
dexamfetamine-
[methylphenidate-
IR]-atomoxetine:
£1,241,570/QALY
(Dexamfetamine-
[methylphenidate-IR]-
atomoxetine) to £1,563
(atomoxetine-
[methylphenidate-MR-12
hours]-dexamfetamine)
No treatment: £1,223
Primary outcome: QALYs
Mean QALYs per child:
Active treatment sequences:
ranging from 0.8273
([methylphenidate-
MR-8hrs]-atomoxetine-
dexamfetamine) to 0.8289
(dexamfetamine-
[methylphenidate-IR]-
atomoxetine)
No treatment: 0.7727
12 years)
Discounting: only in
secondary analysis,
6% in costs and
1.5% in benefits; not
needed in the
primary analysis
Internal validity:
26/4/5
Study Intervention Study population Study type Costs: description and values Results: Comments
and country details Study design Outcomes: description Cost Internal validity
Data sources and values effectiveness (Yes/No/NA)
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