Assessing the Impact of Economic Evidence on Policymakers in Health Care - A Systematic Review

Economic evidence contributes to the organization of efficient health care and to the promotion of the best health outcomes within budgetary constraints. Despite some inherent limitations, its importance has increased across the globe amid growing concern over the rise in the costs of health care. In the United States, this is coupled with a Federal presence in health policy regulation and financing, leading to reconsideration of the role of economic and clinical evidence in decisionmaking by leading actors. In the United States, the comparative effectiveness of medical interventions undergoes rigorous evaluation. However, there is limited use of economic data in comparing health interventions and creating rational policy in the United States when compared with best practices in other high-income countries. This is despite repeated calls for integrating economic evaluation data routinely into the U.S. health care policy process. The economic evidence about health care interventions refers to such characteristics as cost, price elasticity, efficiency, and value data, either collected empirically or synthesized in economic modeling.19 Economic evaluation combines economic data, such as cost-utility ratios, net monetary benefit, and total budget impact estimates, leading to summary economic information on the characteristics of interventions. Examples are a cost-utility ratio, a cost-effectiveness ratio, the net monetary benefit, or a total budget impact estimate. Cost-effectiveness analysis is a specific type of formalized economic evaluation commonly used in the consideration of economic evidence in health care. It typically focuses on the incremental changes in costs and health benefits after the introduction of a medical intervention as compared to an initial situation, and is meant to aid rational decisionmaking. This type of analysis has become the most common mechanism for generating economic evidence in decisionmaking both inside and outside the United States. Evidence from systematic reviews of clinical outcomes presently plays an established role in determining the comparative effectiveness of medical interventions and is useful in developing clinical practice guidelines, making efficacy-based coverage decisions, and in formulating general health policy. The processes of searching for and summarizing the results of studies have been standardized with the goal of demonstrating clinical efficacy and effectiveness in a uniform way, using all available information. Systematic reviews may also be valuable in evaluating the economic impact of introducing interventions. Around the world, standardized guides have been developed to conduct state-of-the-art economic evaluations, to include economic data in systematic reviews, to systematically review economic data, and to use systematic reviews to inform economic evaluations. In the United States, however, the systematic inclusion of economic outcomes and the review of economic data in systematic reviews to inform health policy is not standardized as is already the case for clinical outcomes.