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sr-economic

Integrate economic evidence into SRs per Cochrane Handbook Ch 20 + 20.S. Use when the review includes cost-effectiveness, cost-utility, or cost-benefit analyses. CHEERS 2022 compliance, CHEC-list critical appraisal, ICER extraction and synthesis, decision-model integration. Trigger on "economic evaluation", "cost-effectiveness", "cost-utility", "CUA", "CBA", "CEA", "ICER", "QALY", "CHEERS", "CHEC-list", "cost per", "health economics", "incremental cost". Use ONLY when economic evidence is part of the review scope.

personAuthor: TashanworldhubOpenAPI
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Economic Evidence (Cochrane Handbook Ch 20 + 20.S)

Your Role

Guide integration of economic evidence into systematic reviews: search for economic studies, critical appraisal (CHEC-list, EPHPP), ICER extraction and presentation, CHEERS compliance, and decision-model integration.

Prerequisites

  • Included studies (may include full economic evaluations alongside trials or model-based analyses)
  • PICO (for assessing applicability of economic evidence)

Workflow

Step 1: Determine Economic Scope

ASK:

  1. Full economic evaluations only (cost-effectiveness/cost-utility/cost-benefit) OR cost studies too?
  2. Alongside-trial evaluations only OR model-based analyses too?
  3. What perspective? (healthcare, societal, patient)

DOCUMENT: "We included [full economic evaluations only / cost studies]. Perspective was [healthcare/societal]."

Step 2: Search and Screen

Search strategy: NHS EED (if available), PubMed with health economics filter, CEA Registry, HEED.

Search filter: ("cost-effectiveness"[tiab] OR "cost-utility"[tiab] OR "QALY"[tiab] OR "economic"[tiab]) AND (PICO terms)

Step 3: Critical Appraisal

Use CHEC-list for full economic evaluations (19 items):

python3 scripts/checers_extract.py --study Smith2021 --tool chcec

Key CHEC-list items:

  1. Clear research question?
  2. Competing alternatives described?
  3. Effectiveness established?
  4. All relevant costs and outcomes identified?
  5. Costs and outcomes measured and valued appropriately?
  6. Discounting applied (if >1 year)?
  7. Incremental analysis performed?
  8. Sensitivity analysis conducted?
  9. Conclusions follow from data?

Step 4: Extract ICER and Cost Data

Extract structured data:

python3 scripts/economic_extract.py --study Smith2021 --perspective healthcare

Structure:

| Study | Currency | Year | Perspective | Time Horizon | Discount Rate | Costs (I) | Costs (C) | Effects (I) | Effects (C) | ICER | Uncertainty |
|-------|----------|------|-------------|--------------|---------------|-----------|-----------|-------------|-------------|------|-------------|

Step 5: Synthesize Economic Findings

Do NOT pool ICERs across different currencies/countries without PPP adjustment.

INSTEAD, present as a range:

  • By country: "ICERs ranged from [low] to [high] per QALY in high-income countries"
  • By perspective: "Societal perspective gave ICERs [X%] lower than healthcare perspective"
  • By sensitivity analysis: "Results were sensitive to [parameter] in [N] of [M] studies"

Step 6: Interpret for Decision Making

"At a willingness-to-pay threshold of [threshold], the intervention is [cost-effective / not cost-effective / uncertain] based on [N] of [M] studies."

"Key drivers of cost-effectiveness were [parameter 1] and [parameter 2]."

Scripts

scripts/cheers_checklist.py

CHEERS 2022 (28 items) compliance checklist generator. Usage: python3 cheers_checklist.py --study Smith2021

scripts/economic_extract.py

Structured extraction form for full economic evaluations: costs, effects, ICER, sensitivity analyses. Usage: python3 economic_extract.py --study Smith2021 --perspective healthcare

scripts/checers_extract.py

CHEC-list (19 items) critical appraisal for full economic evaluations. Usage: python3 checers_extract.py --study Smith2021 --tool chcec

Assets

assets/cheers-2022-checklist.md

CHEERS 2022 (28 items) full checklist with item descriptions.

assets/economic-extraction-template.csv

Structured extraction form with fields for costs, effects, ICER, sensitivity analysis, and uncertainty.

assets/chec-list.md

CHEC-list critical appraisal tool (19 items) with EM-specific examples.

assets/cost-effectiveness-glossary.md

Key terms: QALY, DALY, ICER, WTP, CEA, CUA, CBA, discounting, sensitivity analysis.

Guardrails

  1. "Economic SRs are NOT appropriate for all reviews — pre-specify in protocol."
  2. "Do NOT pool ICERs across different currencies/countries without PPP adjustment."
  3. "Perspective matters — societal includes indirect costs, healthcare does not."
  4. "CHEC-list is for full economic evaluations only — use EPHPP for cost-only studies."
  5. "Economic conclusions are jurisdiction-specific — state the setting clearly."
  6. "Model-based economic evaluations are NOT primary studies — they are evidence syntheses themselves."
  7. "Convert all costs to same currency year using GDP deflator or CPI before comparing."

Handoff

→ sr-interpretation (economic conclusions), → sr-writing (economic discussion section)