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Why conduct an economic review?
When the Community Preventive Services Task Force sets review priorities, it carefully considers the public health burden of the behavior or disease of interest, including economic impact. The primary goal of the systematic review is to determine what interventions work to reduce the particular burden. When an intervention is found to be effective, the Community Guide evaluates the intervention’s economic efficiency.
The economic review is critical in understanding:
- Total program costs and the cost per participant in the intervention
- Economic benefits from the intervention
- Whether the intervention results in cost savings
- When there are no cost savings, how much the intervention costs per additional unit of effectiveness
How is an economic review conducted?
The economic review may be conducted:
- Sometimes, as a core part of the effectiveness review, i.e., for policy interventions involving tax/subsidies or other regulations where economic studies comprise the bulk of the effectiveness literature
- More often, as a separate economic evaluation review, after the Task Force recommends an intervention based on strong or sufficient evidence of effectiveness
Studies included in the economic evaluation review must use one of these analytic techniques:
- Cost analysis
- Cost-benefit analysis
- Cost-utility analysis
- Cost-effectiveness analysis
What are the steps in a Community Guide Economic Review?
The process for conducting a systematic economic review is similar to that for an effectiveness review.
- Establish inclusion criteria
- Use intervention and population characteristic criteria from the broader review
- Consider the information source:
- Type of publication, e.g., peer-reviewed, grey literature
- Publication language
- High income economies
- Conduct a literature search, using:
- Economic key words such as economics, cost, benefit, cost-benefit, cost-effectiveness, and cost-utility
- Databases specialized to economics, such as EconLit and Campbell Cochrane Economic Evaluation in addition to those used for effectiveness review literature search
- Repositories of institutions, such as the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), National Institutes of Health (NIH), National Institute for Health and Clinical Excellence (NICE), and Centre for Reviews and Dissemination at the University of York
- Screen titles and abstracts, conducting full text reviews of studies that pass initial screening
- Review and abstract final selected papers, using:
- A standard abstraction form [PDF - 833KB]
- Two reviewers for each study - to assure more thorough, balanced reviews
- Consensus - to resolve differences of opinion about any adjustments
- Rate each study [Note: Only studies rated satisfactory or better are included in the economic review]
- Base quality ratings on five performance categories included in the abstraction process: design, cost, benefit measurements, effects, and analysis
- Assign each study a quality rating of: very good, good, satisfactory, or unsatisfactory
- Tabulate results, adjusting economic estimates as follows
- Use purchasing power parities (PPP) from the World Bank to convert the estimates from foreign studies to US dollars for comparability
- Incorporate the effect of inflation using the Consumer Price Indexes (CPIs) from the Bureau of Labor Statistics (BLS), separately for general goods and services and for medical care
- Take into account the notion that benefits are more desirable now rather than later through a process of discounting
- Reach summary conclusions
- Generate summary economic estimates across all studies or study groupings, as possible
- Present conclusions regarding the economic attractiveness of interventions based on the weight of economic evidence
- Provide Discussions
- Describe differences in materials and methods across studies, as applicable
- Identify variables to which the summary results are particularly sensitive and which are likely to change if the intervention is applied in specialized, but predictable situations
- Identify gaps in the economic literature and suggest future research
Where can I find the results of economic reviews?
Economic reviews are conducted for interventions that the Task Force has found effective and recommends based on strong or sufficient evidence of effectiveness. When a review is conducted, the results are typically included in an economic review section of an intervention publication and in the Web intervention summary. Occasionally, the economic review is published in a separate stand-alone paper.
Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost- effectiveness in health and medicine. New York: Oxford University Press, 1996.
Carande-Kulis VG, Maciosek MV, Briss PA, et al. Methods for systematic reviews of economic evaluations for the Guide to Community Preventive Services. [PDF - 43KB] Am J Prev Med 2000; 18(1S):75–91.
Haddix AC, Teutsch SM, Corso PS, eds. Prevention effectiveness: a guide to decision analysis and economic evaluation. 2nd ed. New York: Oxford University Press, 2003.
Stone, GA et al. Understanding and Using the Economic Evidence, Chapter 11 [PDF - 171KB] in The Guide to Community Preventive Services.
For More on this Topic
- Economics Abstraction Form [PDF - 833KB]
- Campbell and Cochrane Economics
- University of York Center for Health Economics
- National Institute for Health and Clinical Excellence [PDF - 50KB] (NICE Economic Guidelines Manual)
- World Health Organization (CHOICE: Choosing Interventions that are Cost Effective)
- Tufts University (Cost Effectiveness Analysis Registry)
- Washington State Institute for Public Policy