HOW CAN A LOW COST ECONOMIC PERSPECTIVE BE INCLUDED TO A SYSTEMATIC REVIEW: A CASE STUDY OF SYSTEMATIC REVIEW OF SURGICAL TREATMENTS FOR WOMEN WITH STRESS URINARY INCONTINENCE

• Published in: Value in health Vol. 20; no. 5; p. A310
• Main Authors: Aluko, PO, Vale, L, Craig, D, Shemilt, I
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01.05.2017
• Subjects: Cost analysis; Decision making; Economists; Health care expenditures; Health services; Laparoscopy; Reviews; Surgery; Systematic review; Teams; Urinary incontinence; Usefulness; Vagina; Women
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: Extending the scope of Cochrane Intervention Reviews (CIRs) to incorporate economic evidence, alongside evidence for health effects, can increase their usefulness for decision-making. However, the primary methodology for incorporating economic evidence into a CIR - an integrated full systematic review of economic evidence - is time consuming and requires specialist input from a health economist. The Brief Economic Commentary (BEC) methodology is especially designed to support inclusion of economic evidence in CIRs, without placing large additional workload on review teams or requiring specialist input. We demonstrated this framework by applying it in Cochrane reviews investigating the effectiveness and cost-effectiveness of surgical treatments for women with stress urinary incontinence. METHODS: NHS Economic Evaluation Database and MEDLINE were searched to identify eligible cost-of-illness and economic evaluation studies conducted between 1994 and 2016. A short description of the economic burden of the health condition was developed based on the findings of selected cost-of-illness studies and integrated into the background section of the CIR. Basic details of the characteristics and principal findings of included economic evaluations were extracted and summarised in the discussion section. RESULTS: Eligible economic evaluations studies included a systematic review covering various countries and three primary studies from the UK, Finland and Spain. Of the surgeries considered, all of these studies found Tension-free Vaginal Tape (TVT) to be more cost-effective compared with Laparoscopic mesh colposuspension and open colposuspension. However, two studies reported Mid-Urethral Sling procedure (MUS), a much recent surgery, to be less costly and as effective as TVT. CONCLUSIONS: This work confirmed that BECs can summarise relevant economic information for decisionmakers without large additional workload. Development of BECs represents a low cost method for inclusion of economic evidence in systematic reviews when a full integrated systematic review of economic evidence, or modelling economic evidence is beyond scope.