title: What is the quality of economic evaluations of non-drug therapies? A systematic review and critical appraisal of economic evaluations of radiotherapy for cancer.
abstract: BACKGROUND
  Breast, cervical and colorectal cancers are the three most frequent cancers in women, while lung, prostate and colorectal cancers are the most frequent in men. Much attention has been given to the economic evaluation of pharmaceuticals for treatment of cancer by the National Institute for Health and Care Excellence (NICE) in the UK and similar authorities internationally, while economic analysis developed for other types of anti-cancer interventions, including radiotherapy and surgery, are less common.
  
  
  OBJECTIVE
  Our objective was to review methods used in published cost-effectiveness studies evaluating radiotherapy for breast, cervical, colorectal, head and neck and prostate cancer, and to compare the economic evaluation methods applied with those defined in the guidelines used by the NICE technology appraisal programme.
  
  
  METHODS
  A systematic search of seven databases (MEDLINE, EMBASE, CDSR, NHSEED, HTA, DARE, EconLit) as well as research registers, the NICE website and conference proceedings was conducted in July 2012. Only economic evaluations of radiotherapy interventions in individuals diagnosed with cancer that included quality-adjusted life-years (QALYs) or life-years (LYs) were included. Included studies were appraised on the basis of satisfying essential, preferred and UK-specific methods requirements, building on the NICE Reference Case for economic evaluations and on other methods guidelines.
  
  
  RESULTS
  A total of 29 studies satisfied the inclusion criteria (breast 14, colorectal 2, prostate 10, cervical 0, head and neck 3). Only two studies were conducted in the UK (13 in the USA). Among essential methods criteria, the main issue was that only three (10%) of the studies used clinical-effectiveness estimates identified through systematic review of the literature. Similarly, only eight (28%) studies sourced health-related quality-of-life data directly from patients with the condition of interest. Other essential criteria (e.g. clear description of comparators, patient group indication and appropriate time horizon) were generally fulfilled, while most of the UK-specific requirements were not met.
  
  
  CONCLUSIONS
  Based on this review there is a dearth of up-to-date, robust evidence on the cost effectiveness of radiotherapy in cancer suitable to support decision making in the UK. Studies selected did not fully satisfy essential method standards currently recommended by NICE.
authors: Centre for Health Economics (CHE), University of York, Heslington, York, YO10 5DD, UK, mc.barbier@libero.it.
authors: M
authors: M
authors: Barbieri
authors: H L A
authors: HL
authors: Weatherly
authors: R
authors: R
authors: Ara
authors: H
authors: H
authors: Basarir
authors: M
authors: M
authors: Sculpher
authors: R
authors: R
authors: Adams
authors: H
authors: H
authors: Ahmed
authors: C
authors: C
authors: Coles
authors: T
authors: T
authors: Guerrero-Urbano
authors: C
authors: C
authors: Nutting
authors: M
authors: M
authors: Powell
mesh_terms: D026683:Advisory Committees; D001943:Breast Neoplasms / Q000191:economics / Q000532:radiotherapy; D015179:Colorectal Neoplasms / Q000191:economics / Q000532:radiotherapy; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005069:Evaluation Studies as Topic; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics / Q000532:radiotherapy; D006801:Humans; D008297:Male; D018803:Models, Economic; D009369:Neoplasms / Q000191:economics* / Q000532:radiotherapy*; D011471:Prostatic Neoplasms / Q000191:economics / Q000532:radiotherapy; D019057:Quality-Adjusted Life Years; D011878:Radiotherapy / Q000191:economics*; D006113:United Kingdom; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000532:radiotherapy