Incorporating information about cost-effectiveness into evidence-based decision-making: the evidence-based practice center (EPC) model.
BACKGROUND
There is a pressing need for guidance on how to incorporate economic information into evidence-based decision-making. Such guidance should take account of the quality and relevance of economic evaluations.


OBJECTIVE
To summarize lessons learned in integrating information from decision analyses and cost-effectiveness analyses.


RESULTS
Several methods used by the Evidence-Based Practice Centers (EPCs) to conduct systematic reviews are applicable to assessing economic studies. We discuss methods to identify key questions for the review of economic studies. Reviews should assess how an economic model incorporates clinical logic and handles uncertainty about effectiveness. As is the case for metaanalysis of interventions, qualitative or quantitative synthesis of economic studies should explore heterogeneity to identify key uncertainties underlying divergent results as well as unsuspected sources of bias.


CONCLUSIONS
Applying EPC methods to synthesis of economic information can increase their relevance to clinicians and policymakers and inform decisions that require tradeoffs between effectiveness and harms of interventions.
Helfand
Mark
M
Portland VA Medical Center and the Oregon Evidence-Based Practice Center, Oregon Health & Sciences University, Portland, Oregon 97239, USA. helfand@ohsu.edu
D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine / Q000191:economics*; D017059:Models, Econometric; D011050:Policy Making; D011785:Quality Assurance, Health Care; D014481:United States; D014492:United States Public Health Service