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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p></div><div class="pagination bk_noprnt"><span class="inactive page_link prev">&lt; Prev</span><a class="active page_link next" href="/books/n/methreseconev/fm.s1/" title="Next page in this title">Next &gt;</a></div></div></div>
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="https://effectivehealthcare.ahrq.gov" title="Agency for Healthcare Research and Quality (US)" class="img_link icnblk_img" ref="pagearea=logo&amp;targetsite=external&amp;targetcat=link&amp;targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-methreseconev-lrg.png" alt="Cover of Assessing the Impact of Economic Evidence on Policymakers in Health Care&#x02014;A Systematic Review" /></a><div class="icnblk_cntnt"><h1 id="_NBK114636_"><span itemprop="name">Assessing the Impact of Economic Evidence on Policymakers in Health Care&#x02014;A Systematic Review</span></h1><p><i>Methods Research Reports</i></p><p class="contrib-group">Investigators: <span itemprop="author">Louis W Niessen</span>, MD, PhD, <span itemprop="author">John Bridges</span>, PhD, <span itemprop="author">Brandyn D Lau</span>, MPH, <span itemprop="author">Renee F Wilson</span>, MS, <span itemprop="author">Ritu Sharma</span>, BS, <span itemprop="author">Damian G Walker</span>, PhD, <span itemprop="author">Kevin D Frick</span>, PhD, and <span itemprop="author">Eric B Bass</span>, MD, MPH.</p><a data-jig="ncbitoggler" href="#__NBK114636_ai__" style="border:0;text-decoration:none">Author Information and Affiliations</a><div style="display:none" class="ui-widget" id="__NBK114636_ai__"><p class="contrib-group"><h4>Authors</h4>Investigators: <span itemprop="author">Louis W Niessen</span>, MD, PhD, <span itemprop="author">John Bridges</span>, PhD, <span itemprop="author">Brandyn D Lau</span>, MPH, <span itemprop="author">Renee F Wilson</span>, MS, <span itemprop="author">Ritu Sharma</span>, BS, <span itemprop="author">Damian G Walker</span>, PhD, <span itemprop="author">Kevin D Frick</span>, PhD, and <span itemprop="author">Eric B Bass</span>, MD, MPH.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> Johns Hopkins University Evidence-based Practice Center</div></div><div class="half_rhythm">Rockville (MD): <a href="https://effectivehealthcare.ahrq.gov" ref="pagearea=meta&amp;targetsite=external&amp;targetcat=link&amp;targettype=publisher"><span itemprop="publisher">Agency for Healthcare Research and Quality (US)</span></a>; <span itemprop="datePublished">2012 Oct</span>.<div class="small">Report No.: 12(13)-EHC133-EF</div></div><div class="half_rhythm"><ul class="inline_list"><li><span class="label"><a data-jig="ncbidialog" href="#_ncbi_dlg_cpyrght_NBK114636" data-jigconfig="modal:true">Copyright and
Permissions</a></span></li></ul></div><div id="_ncbi_dlg_cpyrght_NBK114636" style="display:none" title="Copyright and&#10; Permissions"><div>This publication is in the public domain. For more information, see the <a href="/books/about/copyright/">Bookshelf Copyright Notice</a>.</div></div><div class="bk_noprnt"><form method="get" action="/books/n/methreseconev/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div itemprop="description"><h2>Structured Abstract</h2><div id="background"><h4 class="inline">Background:</h4><p>Many health care experts are demanding greater use of economic evidence in the assessment of new and existing health technologies.</p></div><div id="objectives"><h4 class="inline">Objectives:</h4><p>To assess whether and how economic evidence has an impact on health care decisionmaking in the United States and in other countries and to identify antecedents or obstacles for use in health policy.</p></div><div id="data_sources"><h4 class="inline">Data Sources:</h4><p>Searches of MEDLINE, EconLit, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase<sup>&#x000ae;</sup>, and ISI Web of Science<sup>SM</sup> from 1991 until January 2012.</p></div><div id="review_methods"><h4 class="inline">Review Methods:</h4><p>The review included original studies that applied a quantitative or qualitative method for evaluating use of economic evidence in any country. We excluded articles that were opinion- or experienced-based without newly generated data. Paired reviewers independently determined whether articles met eligibility criteria and then extracted data from eligible studies. Reviewers also assessed the quality of each study and graded the strength of the body of evidence using an adaptation of the grading of recommendations assessment development and evaluation (GRADE) recommendations, indicating study limitations, quality, strength of findings, and the type of data available.</p></div><div id="result"><h4 class="inline">Results:</h4><p>Of 19,127 titles initially screened, 43 studies were included, with all but five published since 2000. The most frequently studied countries were the United Kingdom (15), and Australia, Canada, and the United States (5 each). Most studies (27 studies) considered national-level policy and examined the key health actors involved. Important decisionmaking topics were reimbursement and health package decisions, and priority setting in program development.</p><p>Thirty studies found evidence that use of economic evidence had a &#x0201c;substantial&#x0201d; impact on health care policymaking, 27 of which emphasized at least one other criterion, such as equity considerations, usually ill-defined (14 studies), clinical effectiveness, budget impact, ethical reasons, and advocacy arguments. The 30 studies confirmed the acceptance of economic evidence as having an impact on either general policy or specific decisions, such as reimbursement decisions. In 11 of the studies, the use of economic evidence had only a &#x0201c;limited&#x0201d; impact on health policy decisions. In two studies, economic evidence had no impact on health policymaking.</p><p>A few factors played a key role in the use of economic evidence: (1) quality and transparency of the studies that provided the economic evidence was a promoting factor (7 studies) in the case of a good study and a strong obstacle in the case of a poorly presented study (18 studies); (2) transparency and quality of the decisionmaking process was important in the acceptance or rejection of the decision (10 studies for acceptance, 13 studies for rejection); and (3) clarity of the economic information and the way it was communicated were promoting factors (7 studies), while lack of clarity was an obstacle in accepting evidence (17 studies).</p><p>Of the 37 observational studies of policy impact, 11 (30%) received a favorable rating on more than three of the 8 items on the study quality checklist. Five of the studies had a comparison group and provided intermediate quality evidence that economic evidence is useful in general health policymaking.</p></div><div id="conclusions"><h4 class="inline">Conclusions:</h4><p>The body of evidence on the use of economic evidence in policy is small and patchy. It shows that the utility of economic evidence, alone or in combination with systematic reviews, is influenced by technical issues, such as transparency and clarity, as well as by the transparency of the decisionmaking process.</p></div></div><div><h2>Contents</h2><div class="bktoc_all_cntnr top align_right" style="display:none"><ul class="inline_list_right"><li><a class="bktoc_all_exp" href="#">Expand All</a></li><li style="margin-left:.8em"><a class="bktoc_all_clps" href="#">Collapse All</a></li></ul></div><ul id="toc_tllNBK114636_fm_s1" class="simple-list toc toc-toggle"><li class="half_rhythm" id="toc_itm_NBK114636_fm_s1"><a href="/books/n/methreseconev/fm.s1/" class="toc-item">Preface</a></li><li class="half_rhythm" id="toc_itm_NBK114636_ack"><a href="/books/n/methreseconev/ack/" class="toc-item">Acknowledgments</a></li><li class="half_rhythm" id="toc_itm_NBK114636_fm_s2"><a href="/books/n/methreseconev/fm.s2/" class="toc-item">Technical Expert Panel</a></li><li class="half_rhythm" id="toc_itm_NBK114636_fm_s3"><a href="/books/n/methreseconev/fm.s3/" class="toc-item">Peer Reviewers</a></li><li class="half_rhythm" id="toc_itm_NBK114636_introduction"><a href="/books/n/methreseconev/introduction/" class="toc-item">Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK114636_methods"><a href="/books/n/methreseconev/methods/" class="toc-item">Methods</a><ul id="toc_lst_NBK114636_methods_s1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK114636_methods_s1"><a href="/books/n/methreseconev/methods/#methods.s1" class="toc-item">Key Questions and Definition of Terms</a></li><li class="half_rhythm" id="toc_itm_NBK114636_methods_s17"><a href="/books/n/methreseconev/methods/#methods.s17" class="toc-item">Quality of the Reviewed Studies and Grading the Evidence</a></li><li class="half_rhythm" id="toc_itm_NBK114636_methods_s18"><a href="/books/n/methreseconev/methods/#methods.s18" class="toc-item">Description of the Review Methodology</a></li><li class="half_rhythm" id="toc_itm_NBK114636_methods_s19"><a href="/books/n/methreseconev/methods/#methods.s19" class="toc-item">Literature Search and Study Selection</a></li><li class="half_rhythm" id="toc_itm_NBK114636_methods_s24"><a href="/books/n/methreseconev/methods/#methods.s24" class="toc-item">Peer Review</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK114636_results"><a href="/books/n/methreseconev/results/" class="toc-item">Results</a><ul id="toc_lst_NBK114636_results_s1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK114636_results_s1"><a href="/books/n/methreseconev/results/#results.s1" class="toc-item">Findings</a></li><li class="half_rhythm" id="toc_itm_NBK114636_results_s11"><a href="/books/n/methreseconev/results/#results.s11" class="toc-item">Quality of Individual Studies and Grading of the Body of Evidence</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK114636_discussion"><a href="/books/n/methreseconev/discussion/" class="toc-item">Discussion</a><ul id="toc_lst_NBK114636_discussion_s1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK114636_discussion_s1"><a href="/books/n/methreseconev/discussion/#discussion.s1" class="toc-item">Methodological Aspects</a></li><li class="half_rhythm" id="toc_itm_NBK114636_discussion_s2"><a href="/books/n/methreseconev/discussion/#discussion.s2" class="toc-item">Generalizability and Transferability of Results&#x02014;Limitations</a></li><li class="half_rhythm" id="toc_itm_NBK114636_discussion_s3"><a href="/books/n/methreseconev/discussion/#discussion.s3" class="toc-item">Strategies to Improve the Use of the Economic Evidence</a></li><li class="half_rhythm" id="toc_itm_NBK114636_discussion_s4"><a href="/books/n/methreseconev/discussion/#discussion.s4" class="toc-item">Conclusion/Discussion</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK114636_references_rl1"><a href="/books/n/methreseconev/references.rl1/" class="toc-item">References</a></li><li class="half_rhythm" id="toc_itm_NBK114636_appa"><a href="/books/n/methreseconev/appa/" class="toc-item">Appendix A Search Strategies</a></li><li class="half_rhythm" id="toc_itm_NBK114636_appb"><a href="/books/n/methreseconev/appb/" class="toc-item">Appendix B Title Review Form</a></li><li class="half_rhythm" id="toc_itm_NBK114636_appc"><a href="/books/n/methreseconev/appc/" class="toc-item">Appendix C Abstract Review Form</a></li><li class="half_rhythm" id="toc_itm_NBK114636_appd"><a href="/books/n/methreseconev/appd/" class="toc-item">Appendix D Article Inclusion/Exclusion Forms</a></li><li class="half_rhythm" id="toc_itm_NBK114636_appe"><a href="/books/n/methreseconev/appe/" class="toc-item">Appendix E Data Abstraction Form</a></li><li class="half_rhythm" id="toc_itm_NBK114636_appf"><a href="/books/n/methreseconev/appf/" class="toc-item">Appendix F Study Quality Form</a></li><li class="half_rhythm" id="toc_itm_NBK114636_appg"><a href="/books/n/methreseconev/appg/" class="toc-item">Appendix G Excluded Articles</a></li></ul><div class="bktoc_all_cntnr align_right" style="display:none"><ul class="inline_list_right"><li><a class="bktoc_all_exp" href="#">Expand All</a></li><li style="margin-left:.8em"><a class="bktoc_all_clps" href="#">Collapse All</a></li></ul></div></div><div><p><b>Prepared for:</b>
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services<a class="bk_pop" href="#address1"><sup>1</sup></a>,
<b>Contract No.</b>
<b>290-2007-10061-I</b>. <b>Prepared by:</b>
The Johns Hopkins University Evidence-based Practice Center, Baltimore, MD</p></div><div><h4 class="inline">Suggested citation:</h4><p>Niessen LW, Bridges J, Lau BD, Wilson RF, Sharma R, Walker DG, Frick KD, Bass EB. Assessing the Impact of Economic Evidence on Policymakers in Health Care&#x02014;A Systematic Review. Methods Research Report (Prepared by the Johns Hopkins University Evidence-based Practice Center under contract No. 290-2007-10061-I). AHRQ Publication No. 12(13)-EHC133-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2012. <a href="http://www.effectivehealthcare.ahrq.gov/reports/final.cfm" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">www.effectivehealthcare.ahrq.gov/reports/final.cfm</a>.</p></div><div><p>This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10061-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.</p><p>The information in this report is intended to help health care decisionmakers&#x02014;patients and clinicians, health system leaders, and policymakers, among others&#x02014;make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.</p><p>This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.</p><p>None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.</p></div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="address1"><p class="no_top_margin">540 Gaither Road, Rockville, MD 20850; <a href="http://www.ahrq.gov" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">www<wbr style="display:inline-block"></wbr>.ahrq.gov</a></p></div></dd></dl></div></div></div>
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