Development of a Tool for Quality Assessment of Health Economic Evaluations

OBJECTIVES: Health economic analyses (HEAs) compare the necessary investments and health consequences obtained for two or more technologies, assisting in resource allocation. How HEAs are conducted directly impacts the results obtained. Therefore, it is essential to consider their quality during decision-making. The aim of this study was to develop a domain-based tool for the critical assessment of cost-effectiveness and cost-utility studies.

METHODS: We conducted a scoping review to identify tools available for the critical assessment of HEAs and we extracted the items/recommendations they provided. Based on the tool’s items and the discussions of the working group, we identified domains related to the methodological quality of HEAs to be included in the new tool. Subsequently, the items extracted during the scoping review were classified according to the previously defined domains and were used to identify complementary aspects that should be included in the new tool.

RESULTS: We identified 21 tools, all checklists ranging from 7-80 items. Four quality domains to structure the new tool were established: I) Applicability of the research question, II) Model structure, III) Model parameters, and IV) Precision of the result. Assessment of each domain is guided by signaling questions. The first domain assesses applicability of the research question to the desired setting; the second, whether the model adequately represents the complexity of the clinical condition; the third, the quality (certainty) of the key parameters used in the model; and the fourth, the certainty of the incremental cost-effectiveness/utility ratio.

CONCLUSIONS: The tool was developed to integrate critical aspects that impact the methodological quality of HEAs, and that are often missing in other tools. Quality of reporting was not included, as it is already tackled by existing tools. A multidisciplinary panel with different key stakeholders is being organized to review and enhance this first version of the tool.