Understanding the underutilisation of evidence from economic evaluations in healthcare: a mixed methods design

Objectives: Economic evaluation is well regarded by policymakers as a tool for healthcare priority setting, but is often not used in practice. We explored the perspectives of both users (stakeholders) and producers (health economists) of economic evaluations to understand the underutilisation of economic evidence in healthcare decision making. 

Methods: A mixed methods approach was used. Stakeholders (health professionals, healthcare administrators or managers, and health researchers) were surveyed regarding to understand the factors that determine whether they use evidence from economic evaluations. The relative importance of these factors was measured using a discrete choice experiment. Perspectives of health economists were gathered through semi-structured interviews.

Results: The survey was answered by 93 stakeholders. Important factors to stakeholders included quality of clinical evidence, quality of economic evidence, timeliness, applicability, communication and conflicts of interest. Ten health economists participated in semi-structured interviews. They discussed methods they used to translate their research into healthcare practice. Topics discussed included the nature of stakholder engagement and how the production of of economic evidence was tailored to meet specific contextual needs. It was generally considered best when stakeholder engagement begins early and is maintained throughout the research process.

Conclusions: These findings are being used to inform recommendations for translating evidence from economic evaluation into clinical practice. Such recommendations need to balance stakeholder needs with the constraints that health economists face.