CHEC list: Consensus Health Economic Criteria

Background

Health care professionals, consumers, researchers, and policymakers can be overwhelmed by the sometimes unmanageably large number of studies on the efficacy and cost-effectiveness of health care interventions. Systematic reviews of these studies can help in making well-informed decisions on which intervention to adopt.

Together with other partners the Maastricht University has developed a series of articles on how to perform a systematic review of economic evaluations according to the standard. These series are freely available, please use the following links:

• How to prepare a systematic review of economic evaluations for informing evidence-based healthcare decisions: a five-step approach (part 1/3) > view article.
• How to prepare a systematic review of economic evaluations for clinical practice guidelines: database selection and search strategy development (part 2/3) > view article.
• How to prepare a systematic review of economic evaluations for informing evidence-based healthcare decisions: data extraction, risk of bias, and transferability (part 3/3) > view article.

For maximum usefulness, systematic reviews of cost-effectiveness studies should be transparent, of high methodological quality and informative. The aim of the CHEC-project is to develop an internationally accepted criteria list for quality assessment of economic evaluations that could be used in systematic reviews.

Development process

The development of the CHEC-list is, based on expert consensus, similar to the development of a Delphi list (J Clin Epidemiol, 1998) for quality assessment of randomised controlled trials. Based on several search strategies an initial item pool was developed in which items from existing criteria/check lists were included (link to chapter 8 Criteria list for conducting systematic reviews based on economic evaluation studies in Evidence-based Health Economics, Donaldson, Mugford, Vale). On the basis of this item-pool the project team composed a questionnaire. This questionnaire was presented to a Delphi-panel and they were asked which categories and which items (questions) should be incorporated into a criteria list, accompanied by arguments. A large number of international experts participated in our Delphi panel. After two Delphi-rounds the final CHEC-list was constructed. Overall the items included in the CHEC-list are those on which the majority of expert panel agreed. Furthermore the selected item has to give insight into the quality of the study performed rather than into how the study is performed (e.g. “Is the economic study design appropriate to the stated objective?” instead of “What is the used form of analysis?”).

Objectives

The CHEC-list focuses only on the methodological quality of economic evaluations. Other checklists already exist that focus on the methodological quality of more general aspects of clinical effectiveness studies (Control Clin Trials, 1996, 1-12; J Clin Epidemiol). The CHEC-list is suitable for systematic reviews, which include full economic evaluation studies based on clinical trials (cohort studies, case-control studies, randomised controlled clinical trials). The focus on clinical trials is due to practical considerations, as other methodological criteria are relevant when using other designs, e.g. the checklist cannot be used in studies based on modelling or scenario-analysis. Furthermore, the CHEC-list is limited to systematic reviews based on full economic evaluation studies, comparing cost and consequences of two or more alternatives, and in which both costs (inputs) and consequences (outputs) of the alternatives are examined. By using the CHEC-list as a minimum standard all future systematic reviews will be more transparent and comparable. As a result, these systematic reviews will be more easy to use for both researchers and policy makers.

Assessment instruction

The CHEC-list consists of 19 yes-or-no questions one for each category. In some cases insufficient information is available in the article, or in other published material. In those cases the assessor has to tick ‘no’. The assessor should state ‘yes’ if they agree that the study paid sufficient attention to a certain aspect. To help the assessor when filling out the CHEC-list an explanation of the meaning of each item is given in assessment instructions.

Disclaimer

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