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Methodological aspects of economic evaluations conducted in the palliative or end of life care settings: a systematic review protocol.

ABSTRACT: INTRODUCTION:In light of this growing palliative care and end of life care patient population, as well as new (expensive) drugs and treatments, quality research providing evidence for decision-making is required. However, common research guidance is lacking in this field, especially in respect to the methods applied in economic evaluations. Therefore, the aim of the planned systematic review is to identify and summarise relevant information on methodological challenges, potential solutions and recommendations for conducting economic evaluations of interventions in adult patients, irrespective of their underlying disease and gender in the palliative or end of life care settings, with no restrictions in regards to countries/geographical regions. The results of this systematic review may help to clarify the current methodological questions and form the basis of new, setting specific methods guidelines and support ongoing applied economic evaluations in the field. METHODS AND ANALYSIS:A systematic review will be conducted using Medline, Embase, Health Technology Assessment Database and NHS Economic Evaluation Database to identify the studies published from 1999 onwards with relevant information on methodological challenges, potential solutions and recommendations for conducting economic evaluations in the palliative or end of life care settings. Articles in English, German, Spanish, French or Dutch language will be considered. Two independent reviewers will conduct the screening of articles; any discrepancies will be resolved by discussion and involvement of a third reviewer. Predesigned data extraction forms will be applied, consequently narratively synthesised and categorised. Studies' methodological quality will be critically appraised. Besides existing economic guidelines and checklists for specific information on the palliative and end of life care sector will be searched. ETHICS AND DISSEMINATION:Ethical approval is not required, as this is a planned systematic review of published literature. An article will be disseminated in a related peer-reviewed journal, as well as presented at leading palliative care and health economic conferences. PROSPERO REGISTRATION NUMBER:CRD42020148160.

SUBMITTER: Fischer C

PROVIDER: S-EPMC7259853 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Methodological aspects of economic evaluations conducted in the palliative or end of life care settings: a systematic review protocol.

Fischer Claudia C Chwala Eva E Simon Judit J

BMJ open 20200527 5

<h4>Introduction</h4>In light of this growing palliative care and end of life care patient population, as well as new (expensive) drugs and treatments, quality research providing evidence for decision-making is required. However, common research guidance is lacking in this field, especially in respect to the methods applied in economic evaluations. Therefore, the aim of the planned systematic review is to identify and summarise relevant information on methodological challenges, potential solutio ...[more]

PMID: 32467253

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Project description:IntroductionIn the context of family planning and reproductive health, a gender-transformative approach involves helping communities understand and challenge the social norms that perpetuate inequalities between men and women, and improving women's access to key services.The purpose of this systematic review is to synthesise the best available evidence on economic evaluations of gender transformative interventions targeted at preventing unintended pregnancy and promoting sexual health in adolescents, assess the methodological quality of the economic evaluation studies and identify gaps in the evidence.Methods and analysisWe will search the following bibliographic databases for economic evaluations that meet our selection criteria; PubMed, Cochrane, National Health Service EE database, SCOPUS, CINHAL, Web of Science and Paediatric EE Database. We will additionally conduct a grey literature search. The search will be conducted for the period 1 January 1990 to 31 December 2021. Two independent reviewers will conduct the screening, data extraction and quality assessment. We will consider the following outcomes from economic evaluations; relative resource use, cost and incremental cost-effectiveness ratio, incremental net benefit ratio or net present value, quality-adjusted life-years and disability-adjusted life-years. Quality assessment will be conducted using the Consolidated Health Economic Evaluation Reporting Standards statement and the Consensus on Health Economic Criteria checklist. Results will be reported using summary tables and narratively. Attempts will be made to use the Joanna Briggs Institute three-by-three dominance ranking matrix tool to compare relevant cost-effectiveness studies.Ethics and disseminationEthics approval is not required because the review will not use individual patient data, instead publicly available economic evaluation research studies will be used. However, an ethics exemption was obtained from the Stellenbosch University Health Research Ethics Committee, Reference No: X21/05/012. The results of the systematic review will be published in a peer-reviewed journal and presented at a relevant scientific conference.Prospero registration numberCRD42021264698.

Project description:ObjectivesEconomic evaluations often use preference-based value sets (tariffs) for health-related quality of life to quantify health effects. For wellbeing at the end of life, issues beyond health-related quality of life may be important. Therefore, the ICECAP Supportive Care Measure (ICECAP-SCM), based on the capability approach, was developed. A validated German ICECAP-SCM version was published recently. However, tariffs for the German ICECAP-SCM are not available. Therefore, the aim was to determine tariffs for the ICECAP-SCM based on preferences of the German general population.MethodsAn online sample of 2996 participants completed a best-worst scaling (BWS) and a discrete choice experiment (DCE). BWSs required participants to choose the best and worst statement within the same capability state, whereas DCEs required participants to trade-off between two capability states. First, BWS and DCE data were analyzed separately. Subsequently, combined data were analyzed using scale-adjusted conditional logit latent class models. Models were selected based on the stability of solutions and the Bayesian information criterion.ResultsThe two latent class model was identified to be optimal for the BWS, DCE, and combined data, and was used to derive tariffs for the ICECAP-SCM capability states. BWS data captured differences in ICECAP-SCM scale levels, whereas DCE data additionally explained interactions between the seven ICECAP-SCM attributes.DiscussionThe German ICECAP-SCM tariffs can be used in addition to health-related quality of life to quantify effectiveness in economic evaluations. The tariffs based on BWS data were similar for Germany and the UK, whereas the tariffs based on combined data varied. We would recommend to use tariffs based on combined data in German evaluations. However, only results on BWS data are comparable between Germany and the UK, so that tariffs based on BWS data should be used when comparing results between Germany and the UK.

Project description:BackgroundMore patients are dying in non-palliative care settings than in palliative care settings. How health care providers care for adult patients at the end-of-life stage in non-palliative care settings has not been adequately explored. The aim of this study was to explore the experiences of health care providers in caring for patients at the end-of-life stage in non-palliative care settings.MethodsThis is a qualitative study. Twenty-six health care providers from eight health care institutions which are based in Shanghai were interviewed individually between August 2016 and February 2017. Three levels of health care, i.e., acute care, sub-acute care, or primary care, was provided in the health care institutions. The interviews were analyzed using qualitative content analysis.ResultsThree themes emerged from the interviews: (i) Definition of the end-of-life stage: This is mainly defined based on a change in treatment. (ii) Health care at the end-of-life stage: Most patients spent their last weeks in tertiary/secondary hospitals, transferring from one location to another and receiving disease- and symptom-focused treatment. Family-dominated decision making was common when discussing treatment options. Nurses instinctively provided extra care attention to patients, but nursing care is still task-oriented. (iii) Challenges, difficulties, and the future. From the interviews, it was found that pressure from families was the main challenge faced by health care providers. Three urgent tasks before the end-of-life care can become widely available in the future were identified from the interviews, including educating the public on death, extending government support, and creating better health care environment.ConclusionThe end-of-life care system of the future should involve health care institutions at all levels, with established mechanisms of collaboration between institutions. Care should be delivered to patients with various life-threatening diseases in both palliative and non-palliative care settings. But first, it is necessary to address the obstacles to the development of end-of-life care, which involve health care providers, patients and their families, and the health care system as a whole.

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Methodological aspects of economic evaluations conducted in the palliative or end of life care settings: a systematic review protocol.

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Methodological aspects of economic evaluations conducted in the palliative or end of life care settings: a systematic review protocol.

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