ADVERSE EFFECTS IN ECONOMIC MODELS

Are adverse effects incorporated in economic models? An initial review of current practice

Background

Technology assessments, which include a systematic review of clinical effectiveness evidence, together with an economic evaluation, are being used more and more by decision makers to decide which treatments should be recommended. Health care interventions can have negative effects as well as positive benefits and when making treatment recommendations both should be considered. It is not clear that technology assessment reports always consider, and incorporate, the appropriate adverse effects. Methods for reviewing adverse effects and their incorporation into economic models need to be developed together.

As a starting point, the incorporation of adverse effects in technology assessments needs to be surveyed. We propose a short programme of research to identify what, if any, methodological research exists on the incorporation of adverse effects into economic models, and to survey existing practice from published technology appraisals. The aim of this research is to generate a sound body of information upon which to build recommendations for future research and/or best practice.

Findings

A total of eighty reports met the inclusion criteria. In many cases, poor reporting made it difficult to ascertain if there had been any consideration of adverse effects. We suggest that the findings of this survey support a call for much clearer and explicit reporting of adverse effects, or their exclusion, in decision models and for explicit recognition in future guidelines that "all relevant outcomes" should include some consideration of adverse events.

Conducted by: Dawn Craig1, Catriona McDaid1, Tiago Fonseca1, Christian Stock1, Steven Duffy1, Nerys Woolacott1

1. Centre for Reviews and Dissemination, University of York

Further details

Project page on NIHR HTA Programme website

Publications

Craig D, McDaid C, Fonseca T, Stock C, Duffy S, Woolacott N. Are adverse effects incorporated in economic models? A survey of current practice. Int J Technol Assess Health Care. 2010; 26(3):323-9

Craig D, McDaid C, Fonseca T, Duffy S, Stock C, Woolacott N. Are adverse effects incorporated in economic models? An initial review of current practice. Health Technol Assess. 2009; 13(62): 1-181

Funding

Commissioned by the NIHR HTA Programme as part of the Technology Assessment Report (TAR) process