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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
Health Economics
Experimental studies
Epidemiology
Decision theory Cost analysis
Econometrics
Adapted from G. Baio (2013) Bayesian Methods in Health Economics
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
EconomicsHealth Economics
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
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
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.
Example Research Question
Are antiseptic washes more effective than non-antiseptic washes at preventing nosocomial infections in patients undergoing surgery?
intervention comparison
outcome population
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
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
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)
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
Reference management
Software Database connectivity
Import format Word processor integration PDF
Organization
BibDesk Good Excellent Lyx GoodEndNote Excellent Good MS Word, OpenOffice, Pages N/AJabRef Good Excellent OpenOffice, MS Word, Lyx N/AKBibTeX Excellent Fair Lyx ?Mendeley Excellent Fair MS Word, OpenOffice ExcellentPapers Excellent Poor MS Word, OpenOffice, Pages FairQiqqa Fair Fair MS Word, Lyx ExcellentDocear Poor Good MS Word, Pages, TexEdit, Lyx ExcellentZotero Good Good MS Word, OpenOffice, GoogleDocs Good
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
Synthesis: complete pooling
𝑦 11 , 𝑦1 2 ,… , 𝑦1𝑛 𝑦 21 , 𝑦 22 ,…, 𝑦2𝑛 𝑦 𝑛1, 𝑦 𝑛2 ,…, 𝑦𝑛𝑛
Study 1 Study 2 Study n
G. Baio (2013) Bayesian Methods in Health Economics
Synthesis: No pooling
1
𝑦 11 , 𝑦1 2 ,… , 𝑦1𝑛 𝑦 21 , 𝑦 22 ,…, 𝑦2𝑛 𝑦 𝑛1, 𝑦 𝑛2 ,…, 𝑦𝑛𝑛
Study 1 Study 2 Study n
2 n
G. Baio (2013) Bayesian Methods in Health Economics
Synthesis: mixed
𝑦 11 , 𝑦1 2 ,… , 𝑦1𝑛 𝑦 21 , 𝑦 22 ,…, 𝑦2𝑛 𝑦 𝑛1, 𝑦 𝑛2 ,…, 𝑦𝑛𝑛
Study 1 Study 2 Study n
1 2 n
G. Baio (2013) Bayesian Methods in Health Economics
Bias in meta-analysisPublication 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