The role of health economic evidence in clinical practice guidelines for colorectal cancer: a comparative analysis across countries
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: Colorectal cancer (CRC) is among the most prevalent malignancies globally and causes massive resource consumption and economic burden. Health economic evidence (HEE) has been used in clinical practice guidelines (CPGs) for cancer to facilitate the rational allocation of health resources. However, in certain guideline development organizations, HEE is not yet utilized as a formal decision-making criterion. This study aimed to compare the discrepancies in the utilization of health economics as evidence in CRC CPGs across different countries and review specific features of economic evidence concerning the guidelines’ applicability. Materials & methods: A systematic review was conducted using databases including Medline, Embase, CNKI, WanFang, and other guidelines databases to identify CPGs for CRC published in English or Chinese from January 2017 to September 2023. Data on the incorporation and application of HEE were extracted, and the method and quality of cost–effectiveness analysis (CEA) studies were evaluated. Descriptive analyses were used to summarize the results. Results: Out of 53 CPGs from 14 countries, most originated from the USA (n = 17 of 53 [32%]) and Canada (n = 9 of 53 [17%]). Sixty-eight percent (36/53) considered cost justification, and 57% (30/53) incorporated health economics studies as evidence. The included HEE cited in CPGs ranged from 1990 to 2021 and were not aligned with the countries in which the guidelines were issued. Among these CEA studies, 52% (26/50) were related to screening strategies, and 32% (16/50) pertained to treatment measures. The Markov model was the most frequently used (n = 27 of 50 [54%]). Based on the CHEQUE tool, the methodological quality of these CEA studies was inadequate in areas such as multiple data sources, approaches to select data sources, assessing the quality of data, and relevant equity or distribution. Conclusion: In summary, 57% of guidelines incorporated health economics studies as evidence, with a variation between different countries. The included HEE still had deficiencies in methodology and reporting quality. In the future, it is suggested that health economics research should use a standardized methodology and reporting approach to assist in clinical decision making.
Plain language summary
What is this article about?
Based on healthcare evidence and expert opinion, clinical practice guidelines (CPGs) are an important reference to help healthcare practitioners make scientific decisions. The inclusion of health economic evidence (HEE) in CPGs promotes the efficient utilization of health resources. This study aims to evaluate whether HEE was considered in developing CPGs of colorectal cancer across different countries and review the applicability, methodology, and quality of these health economics studies.
What were the results?
We included 53 CPGs and extracted 80 HEE studies from them, including 50 cost–effectiveness analysis (CEA) studies. The application of HEE in CPGs showed discrepancies between different countries and medical associations. HEE research contributed to cost-based de-escalation of treatment strategies, reporting the economic burden of the disease and elucidating the health-economic comparative benefits of the intervention. Based on the CHEQUE evaluation tool, the methodological and reporting quality of these CEA studies cited as references demonstrated deficiencies.
What do the results mean?
The incorporation of HEE into CPGs as a form of supporting evidence still varies globally. In addition, guidelines tend to ignore the applicability of results from a single HEE. The integration of HEE into CPGs remains challenging.
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Received: 1 December 2024
Accepted: 31 January 2025
Published online: 19 February 2025
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The role of health economic evidence in clinical practice guidelines for colorectal cancer: a comparative analysis across countries. (2025) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2024-0226
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