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Methodological Quality of SCS Cost-Effectiveness Analyses

Methodological Quality of SCS Cost-Effectiveness Analyses. Rui Duarte, MSc, PhD Health Technology Assessment Lead, Liverpool Reviews and Implementation Group, University of Liverpool Rod Taylor, MSc, PhD Chair of Population Health Research, University of Glasgow

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Methodological Quality of SCS Cost-Effectiveness Analyses

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  1. Methodological Quality of SCS Cost-Effectiveness Analyses Rui Duarte, MSc, PhD Health Technology Assessment Lead, Liverpool Reviews and Implementation Group, University of Liverpool Rod Taylor, MSc, PhD Chair of Population Health Research, University of Glasgow Professor of Health Services Research & Director of Exeter CTU & NIHR Senior Investigator, University of Exeter Medical School IMMPACT - Research Design Considerations for Randomized Clinical trials of spinal cord stimulation for pain, November 14-16, 2018, Washington DC

  2. Previous SRs of CEAs of SCS

  3. Aim • What are the research methods employed, which outcomes are assessed, how are these reported, and what are the results of economic evaluations of SCS?

  4. Methods – study identification • Databases: MEDLINE, MEDLINE Epub Ahead of Print & MEDLINE In-Process, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, CEA Registry & hand searches of included studies • Added economic specific terms 1. spinal cord stimulat$.ti,ab,kw. 2. dorsal column stimulat$.ti,ab,kw. 3. epidural stimulat$.ti,ab,kw. 4. or/1-3 5. (cost-effectiveness or cost-utility).mp. 6. incremental cost-effectiveness ratio.mp. 7. incremental cost-utility ratio.mp. 8. (QALY or LY or life year$).mp. 9. or/5-8 10. 4 and 9

  5. Methods – study selection • Two reviewers (RT & RD) reviewed all titles and abstracts • Inclusion/exclusion criteria

  6. Methods – study quality • Quality of included SCS cost-effectiveness studies assessed using the CHEERS checklist • 24-questions assess quality of reporting

  7. Results – included studies

  8. Results – quality assessment

  9. Results – methodological quality

  10. Conclusions • Quality of included SCS CEA studies as assessed by CHEERS quality of reporting checklist was generally high • Limitation of this analysis: CHEERS checklist developed as a ‘CONSORT for CEA studies’ • assists authors and reviewers to check if those items are described but does not account for the appropriateness of what the authors have done (like the risk of bias tool for RCTs as an example).

  11. Conclusions cont. • Recommendations for future SCS CEAs • Base model-based analyses effectiveness estimates of (non-biased) RCT evidence • And preferably a systematic review/meta-analysis of the literature rather than ‘cherry picking’ studies • Improved specific reporting on: perspective/comparator/discount rates/time horizon/exploration of population heterogeneity (subgroups)

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