Brief introduction of health economics and systematic review

1. Health Economics
and
Systematic Review
Son Nghiem

2. HEALTH ECONOMICS

3. What is health economics?
A branch of economics concerned with issues related to
efficiency, effectiveness, value and behavior in the
production and consumption of health and health care
Adapted from G. Baio (2013) Bayesian Methods in Health Economics

4. What do health economists do?
• Analyze the efficiency and equity in health care
financing
• Identify determinants of health care demand
• Estimate and predict of trends in health care costs
• Determine the labor market in health care
• Analyzing the budget system and inventory
management
Health
care
Economics
Health
Economics

5. What is a Systematic Review?
A review of a clearly
formulated question
that uses systematic
and explicit methods
to identify, select, and
critically appraise
relevant research, and
to collect and analyze
data from the studies
that are included in the
review.
Cochrane Collaboration (2005) Glossary of Terms in The
Cochrane Collaboration

6. Systematic vs Traditional Review

7. Question
Scoping
search
Full search
Title and
abstract
screening
Full text
screening
Additional
searching
Included
references
agreed
Data
extraction
Synthesis
Writing up
Reference
management
Protocol
Update
search
Full text
retrieval
Systematic review process
Publication

9. Review Team
• Clinical expert
– Initiates, defines, selects topic.
– Partners in above process, and collaborates in review to prevent bias.
• Statistician
– Provides methodological oversight, ensures process quality for entire
project.
• Librarian
– Provides methodological oversight, ensues process quality for
information search process.
• Healthcare consumer
– Provides insight into the priorities for research, information conduit
for relating priorities and findings between consumers and clinicians.

10. Research Questions

11. Example Research Question
Are antiseptic washes more effective than non-
antiseptic washes at preventing nosocomial
infections in patients undergoing surgery?
intervention comparison
outcome population

12. Mind map research question
Research
question
1st
theme
4th
theme
3rd
theme
2nd
theme
synonym
synonym
synonym
synonym
synonym
synonym
synonym
synonym
synonym
synonym synonym
synonym

13. Construct search phrases
1st theme OR OR OR
AND
2nd theme OR OR OR
AND
3rd theme OR OR OR
AND
4th theme? OR OR OR

14. Example search phrase
(cost benefit* or cost effectiveness
or economic*)
AND
(disability
insurance[Title/Abstract] OR
national health[Title/Abstract] OR
health insurance[Title/Abstract])
NOT
(drug* or obesity or diabetes or
cancer or heart or wound* or
disease or illness)

15. Identifying sources
• Databases?
Cochrane, NHS EED, HTA, DARE, Bibliomap
• Websites?
Google? Search by Organisation
• Hand searching?
Which journals are key to your work?
• Snowballing?
WoK or Scopus
• Books?
LibrarySearch or COPAC or GoogleBooks
• Grey literature?
Google: blog search; SIGLE; conference
proceedings
• Ongoing trials?
Trials registers

16. Reference management
Software
Database
connectivity
Import
format
Word processor integration
PDF
Organization
BibDesk Good Excellent Lyx Good
EndNote Excellent Good MS Word, OpenOffice, Pages N/A
JabRef Good Excellent OpenOffice, MS Word, Lyx N/A
KBibTeX Excellent Fair Lyx ?
Mendeley Excellent Fair MS Word, OpenOffice Excellent
Papers Excellent Poor MS Word, OpenOffice, Pages Fair
Qiqqa Fair Fair MS Word, Lyx Excellent
Docear Poor Good MS Word, Pages, TexEdit, Lyx Excellent
Zotero Good Good MS Word, OpenOffice, GoogleDocs Good

17. META-ANALYSIS
• The analysis of other analyses
• Uses data from randomized controlled trials
• Aggregates and combines the results of
comparable studies into a coherent account to
discover main effects
• Often uses statistical processes
• Looks at effect size, not only statistical
significance
• Combines the results of small-scale studies
• Uses transparent means to draw conclusions
Meta-analysis

18. Synthesis: complete pooling

𝑦11, 𝑦12, … , 𝑦1𝑛 𝑦21, 𝑦22, … , 𝑦2𝑛 𝑦 𝑛1, 𝑦 𝑛2, … , 𝑦 𝑛𝑛
Study 1 Study 2 Study n
G. Baio (2013) Bayesian Methods in Health Economics

19. Synthesis: No pooling
1
𝑦11, 𝑦12, … , 𝑦1𝑛 𝑦21, 𝑦22, … , 𝑦2𝑛 𝑦 𝑛1, 𝑦 𝑛2, … , 𝑦 𝑛𝑛
Study 1 Study 2 Study n
2 n
G. Baio (2013) Bayesian Methods in Health Economics

20. Synthesis: mixed

𝑦11, 𝑦12, … , 𝑦1𝑛 𝑦21, 𝑦22, … , 𝑦2𝑛 𝑦 𝑛1, 𝑦 𝑛2, … , 𝑦 𝑛𝑛
Study 1 Study 2 Study n
1 2 n
G. Baio (2013) Bayesian Methods in Health Economics

21. Bias in meta-analysis
Publication bias:
Studies never published
Studies with no beneficial effect of treatment
Studies sponsored by pharmaceutical industry
Studies from a single centre versus multiple centers
Language bias:
Positive findings published in a international journal
Negative findings published in a local journal
Database bias:
Journals not indexed in major databases
“Doing a meta-analysis is easy, doing one well is hard”
Ingram Olkin