Issues

These main areas for development have been iden-tified as keys to more effective communication:

1. Relevance: Is it needed?
2. Usefulness: Will the intended audience be able to make use of it?
3. Credibility: Is it believable?

Relevance

Is the message relevant for its intended audience? How well we meet the needs of the intended audi-ence depends on how well we know them. Who are they? What information do they need to make appropriate choices? What is their decision-mak-ing process? What is their level of understanding and expertise?

This information can be obtained from numer-ous sources. However, the target audience itself should be involved in the delineation of its needs and process, although assistance from the produc-ers of health economic information may be needed, according to the degree of experience of the user.

Among the points to be considered when evalu-ating relevance are:

1. the varied information needs of end-users and their magnitude of importance;
2. the changing environment or time constraints in which decisions are being made;
3. the predominant influence(s) over those mak-ing them, for example, political, social, bud-getary, clinical, or logistical.

There is often disagreement between researchers and their audiences concerning relevance of research design to the application of its results. Greater awareness of both the intended purpose of the re-search and the objectives of the user before the study is designed may help to reduce that conflict.

Usefulness

Will the information be useful to its intended end-user? These areas were identified as issues with re-gard to the usefulness of health economic informa-tion:

1. reporting standards;
2. communication formats;
3. content.

Reporting Standards. How much standardiza-tion is wanted? There are distinct benefits to hav-ing 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 al-lows faster integration of new information, and they promote comparability across studies. For educational purposes, they simplify the learning process and facilitate the work of editors and re-viewers in the review and evaluation of health eco-nomic documents. Creating standard formats for all types of health economic communications will help end-users wade through the overload of in-formation available, more quickly comprehend the message, and be able to compare it for deci-sion-making purposes.

Creation of reporting standards for all types of health economic studies, clinical studies, model-ing, and database studies, would necessarily be the first step toward 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 ap-propriate communication vehicle? Besides the ones that are most familiar (abstracts, posters, public presentations, reports and articles, health economic communications), more and more com-munications are taking place through other forms of written communication such as targeted brief-ing 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 commu-nication, and its potential role in information transfer.

Content. How useful will the intended audiencesfind the information content? Again, the users of health economic information possess a variety of backgrounds and expertise in this multidisci-plinary 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 than con-sumers. The key is knowing the needs and abilities of an audience.

Credibility

No matter how well presented or potentially use-ful health economic information may be, it will not be used unless the audience finds it credible.

To enhance the believability factor of health eco-nomic information, three areas must be addressed:

1. accepted standards of practice;
2. the concept of disclosure;
3. validation of the information.

Accepted Standards of Practice. Establishing stan-dards of health economic performance is the man-date of other panels, with respect to methodolo-gies, ethics, bias, and conflict of interest. It is important to note, though, that without a set of standardized criteria on which to base judgment of health economic information, only the most ex-perienced audience will be able to feel (rationally) confident about its acceptability.

The Concept of Disclosure. The concept of dis-closure 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, dis-closure goes beyond. The information provider must furnish sufficient detail to enable the audi-ence to make a relevant decision about the infor-mation. The amount and sophistication of the de-tail disclosed will vary according to the expertise and the skills of intended user. At present this con-cept 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 deci-sion 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 knowl-edge for all users of health economic information users (see panel 4, education and skills).

A systematized independent review process of health economic research that provided a measure of validity according to generally accepted stan-dards would increase the level of credibility asso-ciated 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 al-low users to be more comfortable with reported results

Recommendations and Next Steps

To strengthen the relevance, usefulness, and credibil-ity of health economic communication, six areas that require future development have been identified.

Identification of Users and Their Needs

To extend the relevance of ongoing health eco-nomic research, key users of health economic in-formation 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 profes-sional association such as ISPOR.

1. Step 1: Perform a comprehensive evaluation of the literature to determine what has already been published on the subject.
2. 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.
3. Step 3: With the information gathered in step 2, prepare and conduct a survey of all users of health economic information, to provide a ba-sis for standardization of communications.

Standard Communication Formats

To increase usefulness of health economic commu-nications, establish standard communication for-mats based on predetermined relevance, informa-tion, and credibility needs of users and on standard health economic performance standards that should be under development elsewhere. These should eventually include: (1) uniform presentation, (2) standard terminology, (3) adequate disclosure, and

(4) a basis in previously published guidelines [2,3].

Reporting Guidances (RGs)

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 com-munication, 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 ma-jor study type, and over the long term, they should be tailored to each specific type of audience as well.