Critical Appraisal of Systematic Reviews With Costs and Cost-Effectiveness Outcomes: An ISPOR Good Practices Task Force Report [Editor's Choice]


There has been a significant increase in the number of systematic reviews with cost and cost-effectiveness outcomes (SRs-CCEO). The differences in clinical and health settings, heterogeneity in applied methods, and reporting make it challenging to interpret SR-CCEOs. An analysis of guidelines on conducting and reporting SR-CCEOs resulted in the identification of multiple disagreements in these recommendations, suggesting that a standardized approach to conducting SR-CCEOs is necessary. Making universal recommendations for SR-CCEOs is difficult because they differ in several aspects, in particular, with regard to their objectives, eg synthesizing outcomes or assessing the quality of models, search and inclusion criteria, or in reporting solely economic characteristics or economic data alongside clinical outcomes.

This report describes recommendations, organized in six stages, for critically appraising quality and risk of bias in SR- CCEOs: (1) planning and development; (2) search in SR-CCEOs; (3) study selection and eligibility; (4) critical appraisal of the included studies; (5) data extraction and synthesis; (6) presentation and reporting. Naturally, these criteria may be used when conducting SR-CCEO’s. This report includes the ISPOR CrIteria for Cost (-Effectiveness) Review Outcomes (CiCERO) Checklist.  The CiCERO Checklist comprises the report’s recommendations and 13 signalling questions to consider when evaluating the risk of bias in SR-CCEOs, as well as the quality of their conduct and reporting. There is a shorter version of the CiCERO Checklist for reviews that summarize methods of cost and cost-effectiveness studies and a specific version for SR-CCEOs that are using AMSTAR-2.


Olena (Lena) Mandrik J.L. (Hans) Severens Ariel Bardach Salah Ghabri Candyce Hamel Tim Mathes Luke Vale Torbjørn Wisløff Jeremy D. Goldhaber-Fiebert

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