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      Economic Evaluations of Guideline-Based or Strategic Interventions for the Prevention or Treatment of Chronic Wounds

      review-article
      Applied Health Economics and Health Policy
      Springer International Publishing

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          Abstract

          Background

          Costs of chronic wound care are significant, but systematic reviews of cost-effectiveness studies regarding guideline-based or strategic interventions are scarce.

          Objectives

          Our objectives were to assess/compare the cost effectiveness of new interventions/systems designed to improve the prevention/treatment of chronic wounds in adult populations against current care and provide decision makers with information on which to base future interventions for chronic wound management.

          Data Sources

          Data sources included PubMed, Scopus, HTA, and NHS EED.

          Study Eligibility Criteria, Participants, and Interventions

          We included comparative health economic evaluations of interventions published in English designed to prevent or treat adult chronic wounds that were guideline-based or strategic in nature and from which an incremental cost-effectiveness ratio or incremental net health benefit was reported or could be calculated.

          Study Appraisal and Synthesis Methods

          Study and model characteristics and outcomes were extracted into pre-designed tables. Quality assessment of studies was based on literature-reported methods. Studies were assigned strength of evidence ratings and recommendation level for decision makers.

          Results

          A total of 16 health economic evaluations were included, of which ten were trial based and six were wholly model based. Only three studies had high, and five studies moderate, strength of evidence and were recommended for decision makers. All studies had some shortcomings regarding time horizon, costs, effectiveness units, and methodological reporting. Two studies had major flaws.

          Limitations

          Limitations include missed studies published in non-English languages or not cited in searched databases; judgment bias in assessing studies.

          Conclusions and Implications of Key Findings

          Few well conducted cost-effectiveness studies exist to guide decision makers regarding guideline-based or strategic interventions for chronic wounds.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s40258-014-0094-9) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references45

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          Recommendations of the Panel on Cost-effectiveness in Health and Medicine.

          To develop consensus-based recommendations for the conduct of cost-effectiveness analysis (CEA). This article, the second in a 3-part series, describes the basis for recommendations constituting the reference case analysis, the set of practices developed to guide CEAs that inform societal resource allocation decisions, and the content of these recommendations. The Panel on Cost-Effectiveness in Health and Medicine, a nonfederal panel with expertise in CEA, clinical medicine, ethics, and health outcomes measurement, was convened by the US Public Health Service (PHS). The panel reviewed the theoretical foundations of CEA, current practices, and alternative methods used in analyses. Recommendations were developed on the basis of theory where possible, but tempered by ethical and pragmatic considerations, as well as the needs of users. The panel developed recommendations through 2 1/2 years of discussions. Comments on preliminary drafts prepared by panel working groups were solicited from federal government methodologists, health agency officials, and academic methodologists. The panel's methodological recommendations address (1) components belonging in the numerator and denominator of a cost-effectiveness (C/E) ratio; (2) measuring resource use in the numerator of a C/E ratio; (3) valuing health consequences in the denominator of a C/E ratio; (4) estimating effectiveness of interventions; (5) incorporating time preference and discounting; and (6) handling uncertainty. Recommendations are subject to the ¿rule of reason,¿ balancing the burden engendered by a practice with its importance to a study. If researchers follow a standard set of methods in CEA, the quality and comparability of studies, and their ultimate utility, can be much improved.
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            Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria.

            The aim of the Consensus on Health Economic Criteria (CHEC) project is to develop a criteria list for assessment of the methodological quality of economic evaluations in systematic reviews. The criteria list resulting from this CHEC project should be regarded as a minimum standard. The criteria list has been developed using a Delphi method. Three Delphi rounds were needed to reach consensus. Twenty-three international experts participated in the Delphi panel. The Delphi panel achieved consensus over a generic core set of items for the quality assessment of economic evaluations. Each item of the CHEC-list was formulated as a question that can be answered by yes or no. To standardize the interpretation of the list and facilitate its use, the project team also provided an operationalization of the criteria list items. There was consensus among a group of international experts regarding a core set of items that can be used to assess the quality of economic evaluations in systematic reviews. Using this checklist will make future systematic reviews of economic evaluations more transparent, informative, and comparable. Consequently, researchers and policy-makers might use these systematic reviews more easily. The CHEC-list can be downloaded freely from http://www.beoz.unimaas.nl/chec/.
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              • Record: found
              • Abstract: found
              • Article: not found

              Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine.

              This article, the third in a 3-part series, describes recommendations for the reporting of cost-effective analyses (CEAs) intended to improve the quality and accessibility of CEA reports. The Panel on Cost-Effectiveness in Health and Medicine, a nonfederal panel with expertise in CEA, clinical medicine, ethics, and health outcomes measurement, convened by the US Public Health Service. The panel reviewed the theoretical foundations of CEA, current practices, alternative methods, published critiques of CEAs, and criticisms of general CEA methods and reporting practices. The panel developed recommendations through 2 1/2 years of discussions. Comments on preliminary drafts were solicited from federal government methodologists, health agency officials, and academic methodologists. These recommendations are proposed to enhance the transparency of study methods, assist analysts in providing complete information, and facilitate the presentation of comparable cost-effectiveness results across studies. Adherence to reporting conventions and attention to providing information required to understand and interpret study results will improve the relevance and accessibility of CEAs.
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                Author and article information

                Contributors
                +1-307-5875352 , +1-307-5875352 , mcarter@strategic-solutions-inc.com
                Journal
                Appl Health Econ Health Policy
                Appl Health Econ Health Policy
                Applied Health Economics and Health Policy
                Springer International Publishing (Cham )
                1175-5652
                1179-1896
                11 March 2014
                11 March 2014
                2014
                : 12
                : 373-389
                Affiliations
                Strategic Solutions, Inc., 1143 Salsbury Ave, Cody, WY 82414 USA
                Article
                94
                10.1007/s40258-014-0094-9
                4110411
                24615160
                02d708bf-40b9-4c6b-8776-763d4b192b6a
                © The Author(s) 2014

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                Categories
                Systematic Review
                Custom metadata
                © Springer International Publishing Switzerland 2014

                Economics of health & social care
                Economics of health & social care

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