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Issue VII
COMMUNICATION AND REPORTING HEALTH ECONOMIC INFORMATION
Goal
- Identify key issues in communicating and reporting health care economic evaluation information.
Specific Objectives
- Identify and prioritize key issues
- Describe the mechanisms for putting pharmacoeconomic and outcomes information and data into the
same operational format that decision-makers use to make formulary decisions
- Identify the entities, which are conducting/supporting, the research, the purpose of research and their
target audiences for communicating research results
- Discuss outlets of communication of research results and advantages and disadvantages of source and ways
to improve the effectiveness of the outlet.
- Discuss Optimal Formats for communication of Economic Evaluation Results
- Recommend next steps
Co-chairs
- Alan Bakst RPh MS PharmD, Associate Director, Pharmacoeconomics, SmithKline Beecham
- Elaine Power MPP, Senior Policy Analyst, Agency for Healthcare Policy and Research
Panelists
- Lorne Basskin PharmD, Assistant Professor, Butler University
- Laurie Burke RPh MPH, Senior Regulatory Research Officer, US Food & Drug Administration
- Gloria Governali BA, Phase V Communications
- Eduardo Ortiz MD MPH, Associate Director, Outcomes Research, Merck & Company
- Jane Osterhaus, Director, Pharmacoeconomics, G.D. Searle and Company
- Lisa Sanchez PharmD, President, PE Applications
Background and Context
Although a great deal of time, effort and resources are invested in the performance of health economic
evaluations, usually only minimal thought is devoted to most of its communication. This is extraordinary considering that the
primary objective of health economic assessment is to provide healthcare stakeholders with useful tools to assist them in
decision-making, and that effective communication is of key importance in influencing decision-making.
The audiences at which health economic information is directed are as diverse as the decisions that must be made.
From government policy-makers involved in the allocation of federal resources to health care and biomedical research,
through to the patient who needs to play a knowledgeable role in his own health care, each consumer of health economic
information has specific needs. The following are target audiences of health economic information:
- Government policy-makers
- Regulatory agencies
- Healthcare providers
- Healthcare professionals
- the healthcare industry
- researchers and educators
- the public (e.g., consumers, patient interest groups)
For a health economic message to be "heard" by its intended audience, certain criteria must be met. The message
should be:
There are also usually barriers to acceptance of a message which must be overcome before it can be "heard". These
may be explicit or implicit, rational or emotional, they may be specific to the entire target audience or to a subset of it.
To maximize the influence that health economic information may potentially have, these barriers need to be
recognized, identified, and disposed of.
Problem Statement
Users of health economic information represent many different perspectives with various levels of expertise and
information needs. To obtain most value from the resources invested in health economic research, how do we optimize
the effectiveness of our communicating of health economic information?
Issues
Three main areas for development have been identified as keys to more effective communication:
- Relevance: Is it needed?
- Usefulness: Will the intended audience be able to make use of it?
- Credibility: Is it believable?
1. Relevance
Is the message relevant for its intended audience?
How well we meet the needs of the intended audience depends on how well we know them. Who are they? What
information do they need to make appropriate choices? What is their decision-making process? What is their level of
understanding and expertise?
This information can be obtained from numerous sources. However, the target audience itself should be involved
in delineation of its needs and process, although assistance from the producers of health economic information may
be needed, according to the degree of experience of the user.
Among the points to be considered when evaluating relevance are:
- the varied information needs of end-users and their magnitude of importance;
- the changing environment or time constraints in which decisions are being made; and
- the predominant influence(s) over those making them, for example, political, social, budgetary, clinical, or
logistical.
There is often disagreement between researchers and their audiences concerning relevance of research design to
the application its results. Greater awareness of the intended purpose of the research and objectives of the user before
study design may help to reduce that conflict.
2. Usefulness
Will the information be useful to its intended end-user?
Three areas were identified as issues with regard to the
usefulness of health economic information, reporting standards, communication formats and content of the information.
- Reporting standards
How much standardization is wanted? There are distinct benefits to having standard formats for health
economic reporting structures. They allow for greater clarity and understanding of the content, they create a sense
of familiarity with terminology and format that allows faster integration of new information, they promote
comparability across studies. For educational purposes, they simplify the learning process, and facilitate the work of
editors and reviewers in the review and evaluation of health economic documents. Creating standard formats for all
types of health economic communications will help end users wade through the overload of information available,
more quickly comprehend the message, and be able to compare it for decision-making purposes.
Creation of reporting standards for all types of health economic studies, Clinical studies, modeling,
database studies, would necessarily be the first step to standards for publication in peer reviewed journals and
elsewhere, and other modes of communication such as public presentations and posters, and formulary submissions.
- Communication formats
What is the most appropriate communication
vehicle? Besides the ones that are most familiar, I(abstracts,
posters, public presentations, reports and articles, health economic communications), more and more
communications are taking place through other forms of written communication such as targeted briefing documents
and various types of submissions to healthcare providers, on an interpersonal level, or through the mass
media. Consideration should be given to the usefulness of each type of communication, and its potential role in
information transfer.
- Content of Information
How useful will the intended audiences find the information content?
Again, the users of health economic information possess a variety of backgrounds and expertise in this multidisciplinary field. The content of any message
has to be tempered according to the level of sophistication of the users, as well as knowledge of the needs of
the audience. Managed care organizations have different needs than do physicians, who may in turn be looking
for something different from consumers. The key is knowing the needs and abilities of an audience.
3. Credibility
How do we enhance the credibility of health economic communications?
Once a solid base of useful information has
been created and focussed to the needs of the target audience, no matter how well presented it may be, unless the
audience finds it credible, it will not be used. To enhance the believability factor of health economic information, three areas must
be explored, accepted standards of practice, the concept of disclosure, and validation of the information.
- Accepted standards of practice
Establishing standards of health economic performance are the mandates of other panels, with respect to
methodologies, ethics, bias and conflict of interest. It is important to note though that without a set of
standardized criteria on which to base judgement of health economic information, only the most experienced audience will
be able to feel (rationally) confident about its acceptability.
- The concept of disclosure
The concept of disclosure includes more than simple transparency. While transparency provides that all
assumptions and all influences that went into the creation of the health economic information are revealed,
disclosure goes beyond. The information provider must furnish sufficient detail to enable the audience to make a
relevant decision about the information. The amount and sophistication of the detail disclosed will vary according to
the expertise and the skills of intended user. At present this concept is poorly developed; standardization of levels
of disclosure is needed.
- Validation of health economic information
How much protection does the consumer of health economic information want? That will probably depend on
the importance of the decision to be made and the discriminatory abilities of the user to determine the quality of
an analysis, which will in turn depend on their training and experience. There is no one appropriate level of
health economic background needed by all, but clearly there is a need for a basic level of knowledge for all users
of health economic information users (see the education and skills panel).
A systematized independent review process of health economic research that provided a measure of
validity according to generally accepted standards, would increase the level of credibility associated with that research.
It would confirm that a study met acceptable design, methods, conduct, format, disclosure and presentation
standards. As a form of accreditation, this review would allow users to be more comfortable with reported results.
Recommendations and Next Steps
Six areas which require future development have been identified, to strengthen the relevance, usefulness and
credibility of health economic communication.
1. Identification of users and their needs
To extend the relevance of ongoing health economic research, key users of health economic information should
be identified, along with their information needs. This should be a three-step process involving all interested stakeholders,
but should be coordinated by an independent professional association such as ISPOR.
Step 1: Perform a comprehensive evaluation of the literature to determine what has already been published on
the subject
Step 2: Establish working groups that include other interested professional organizations to identify the
relevant stakeholders, the types of information needed, and the potential barriers to communication that exist. This may
be an iterative process, including other stakeholders at later stages
Step 3: With the information gathered in step two, prepare and conduct a survey of all users of health
economic information, to provide a basis for standardization of communications
2. Standard communication formats
To increase usefulness of health economic communications, establish standard communication formats based on
predetermined relevance, information and credibility needs of users and on standard health economic performance
standards that should be under development elsewhere. These should eventually include: a) Uniform presentation, b)
standard terminology, c) adequate disclosure; and d) a basis in previously published guidelines (Uniform requirements 393;
Mason 468).
3. Reporting guidance
As standardized formats are established, Reporting Guidance (RGs) should be adopted by ISPOR and applied to
all publicly presented communications, including ISPOR's journal. Other vehicles of communication, such as other
biomedical journals and internet publishers, should also be encouraged to use these standards. ISPOR Reporting
Guidance should establish reporting standards for each major study type, and over the long term, tailored to each specific type
of audience as well.
4. Biannual surveys
Performance surveys to evaluate the use of Reporting Guidance and the quality of reporting should be undertaken on
a biannual basis.
5. Public accessibility
A principle of publicly accessible reports that adhere to ISPOR RGs should be established. This would allow access
to research reports that is not directly controlled by the researcher or the research organization. Once a report has
been "filed" for public accessibility, all subsequent communications could refer to that report. The following figure illustrates
a scheme for the development of a system for public accessibility.
6. Enhanced peer review
An enhanced mode of peer review should be instituted for all forms of health economic communications. This type
of review would assure that there was compliance with ISPOR RGs and fair, full and adequate disclosure, allow for review
of the underlying data and any model used, and confirm that all other ISPOR standards for the conduct of health
economic studies have been met.
Summary
Pharmacoeconomics has numerous diverse audiences with various perspectives, objectives, backgrounds and skills.
To get the most value from health economic research we need to increase the relevance, usefulness and credibility of
our communications to these audiences. Only by ensuring that we are aware of our audience's true needs and endeavoring
to provide a product they can understand and use, can we have the most impact on decision-making with health
economic tools.
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