Incorporating Economic Methods into Cochrane Systematic Reviews: Case Studies in Brain Tumour Research

Abstract

Abstract Background: Cochrane systematic reviews have established methods for identifying and critically appraising effects evidence in health. In addition to evidence regarding the effects of interventions, the resource implications of such interventions can have a huge impact on decision makers ability to adopt and implement them. We present examples of the three approaches to include economic evidence in Cochrane reviews. Methods: The Cochrane Handbook suggest three different methods of integrating economic evidence into reviews: the Brief Economic Commentary (BEC), the Integrated Full Systematic Review of Economic Evaluations (IFSREE) and using an Economic Decision Model. Using examples from a suite of systematic reviews in brain tumour research, we utilised each method to address three different research questions. A BEC was utilised in a review that evaluates the long-term side effects of radiotherapy (with or without chemotherapy). An IFSREE was utilised in a review assessing different treatment strategies for newly diagnosed glioblastoma in the elderly. Finally, an economic model was included in a review assessing diagnostic test accuracy for tests of codeletion of chromosomal arms in people with glioma Results: The BEC mirrored the results of the main review and found a paucity of quality evidence with regard with regard to side effects of radiotherapy in those with glioma. The IFSREE identified a single economic evaluation regarding glioblastoma in the elderly, but this study had a number of methodological issues. The economic model identified a number of potentially cost-effective strategies for tests for codeletion of chromosomal arms 1p and 19q in people with glioma. Conclusions: There are strengths and limitations of each approach of integrating economic evidence in a Cochrane systematic review. The type of research question, resources available and study timeline should be considered which choosing which approach to use when integrating economic evidence.