A Systematic Review and Quality Assessment of Pharmacoeconomic Publications for China Compared to Internationally: Is the Quality of Evidence-base Sufficient for Health Technology Assessment?

Document Type : Review Article

Authors

1 Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China

2 NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China

3 Center for Health Management and Policy Research, Shandong University, Shandong Provincial Key New Think Tank, Jinan, China

4 Zhucheng Shiqiaozi Health Hospital, Zhucheng, China

5 Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK

6 China National Health Development Research Center, Beijing, China

Abstract

Background 
To summarize the quality of pharmacoeconomic publications for China compared to internationally and to identify areas for improvement both from a China-specific and international perspective.
 
Methods 
First, we conducted a systematic review of pharmacoeconomic publications for China, with subsequent reporting quality assessment based on the CHEERS checklist. Second, we conducted an umbrella review of pharmacoeconomic publications internationally which used a similar quality assessment. We extracted the CHEERS checklist scores for each study and converted them to percentages to facilitate comparison of results.
 
Results 
CHEERS 2022 instrument was used to evaluate the quality of 154 pharmacoeconomic publications by Chinese scholars. Across these articles, the average quality score was 61.0%, indicating a moderate level of quality on average. There were 27 (17.5%) high quality articles, 85 moderate quality articles (55.2%) and 42 low quality (27.3%) articles. Out of 28 scoring items, those included in the methods section such as: Health economic analysis plan, Characterizing heterogeneity, Characterizing distributional effects, Approach to engagement with patients and others affected by the study, got low scores. In addition to the generally lower scores of international articles on items 9 (Time horizon), 18 (Characterizing heterogeneity) and 24 (Effect of uncertainty), Chinese articles also scored lower than international articles on items included in the methods and other relevant information section,e.g.Health economic analysis plan, Perspective, Discount rate, Analytics and assumptions, Characterizing distributional effects, Approach to engagement with patients and others affected by the study, Source of funding and Conflicts of interest.
 
Conclusion 
The quality of China's pharmacoeconomic publications has been improving year by year since the establishment of the NHSA in 2018, but there is still a quality gap with similar international publications which requires further focus and improvement in study conduct and reporting standards for the evidence-base to be sufficient for HTA. 

Keywords


  1. Kesselheim AS, Avorn J, Sarpatwari A. The high cost of prescription drugs in the United States: origins and prospects for reform. JAMA. 2016;316(8):858-871. doi:1001/jama.2016.11237
  2. Hasegawa M, Komoto S, Shiroiwa T, Fukuda T. Formal implementation of cost-effectiveness evaluations in Japan: a unique health technology assessment system. Value Health. 2020;23(1):43-51. doi:1016/j.jval.2019.10.005
  3. O'Rourke B, Oortwijn W, Schuller T. Announcing the new definition of health technology assessment. Value Health. 2020;23(6):824-825. doi:1016/j.jval.2020.05.001
  4. Drummond M. Twenty years of using economic evaluations for drug reimbursement decisions: what has been achieved? J Health Polit Policy Law. 2013;38(6):1081-1102. doi:1215/03616878-2373148
  5. Ikegami N, Drummond M, Fukuhara S, Nishimura S, Torrance GW, Schubert F. Why has the use of health economic evaluation in Japan lagged behind that in other developed countries? Pharmacoeconomics. 2002;20 Suppl 2:1-7. doi:2165/00019053-200220002-00001
  6. Drummond M, Dubois D, Garattini L, et al. Current trends in the use of pharmacoeconomics and outcomes research in Europe. Value Health. 1999;2(5):323-332. doi:1046/j.1524-4733.1999.25003.x
  7. Yang BM. The future of health technology assessment in healthcare decision making in Asia. Pharmacoeconomics. 2009;27(11):891-901. doi:2165/11310280-000000000-00000
  8. Wu J, Sun L, Liu G. Current situation of pharmacoeconomics in China. Chinese Pharmacoeconomics. 2008;15(6):29-36.
  9. Announcement by the National Health Insurance Administration on the Announcement of the 2019 National Health Insurance Drug List Adjustment Work Plan. National Healthcare Security Administration. http://www.nhsa.gov.cn/art/2019/4/17/art_53_1215.html. Accessed March 23, 2024.
  10. Aromataris E, Fernandez R, Godfrey C, Holly C, Khalil H, Tungpunkom P. The Joanna Briggs Institute Reviewers’ Manual 2014: Methodology for JBI Umbrella Reviews. Australia: The Joanna Briggs Institute; 2014.
  11. Husereau D, Drummond M, Augustovski F, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Value Health. 2022;25(1):3-9. doi:1016/j.jval.2021.11.1351
  12. Yu G, Tong S, Liu J, et al. A systematic review of cost‑effectiveness analyses of sequential treatment for osteoporosis. Osteoporos Int. 2023;34(4):641-658. doi:1007/s00198-022-06626-1
  13. Mohammadnezhad G, Noqani H, Rostamian P, Sattarpour M, Arabloo J. Lenvatinib in the treatment of unresectable hepatocellular carcinoma: a systematic review of economic evaluations. Eur J Clin Pharmacol. 2023;79(7):885-895. doi:1007/s00228-023-03502-7
  14. Chiou CF, Hay JW, Wallace JF, et al. Development and validation of a grading system for the quality of cost-effectiveness studies. Med Care. 2003;41(1):32-44. doi:1097/00005650-200301000-00007
  15. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. doi:1136/bmj.j4008
  16. Jing Z, Fei L, Weiling J, et al. Cost-effectiveness analysis of cervical spondylopathy treated by Zhishu Granule based on randomized clinical trial. Chinese Journal of Pharmaceutical Economics. 2018;13(11):50-54.
  17. Desai PR, Chandwani HS, Rascati KL. Assessing the quality of pharmacoeconomic studies in India: a systematic review. Pharmacoeconomics. 2012;30(9):749-762. doi:2165/11590140-000000000-00000
  18. Luo Q, Zhou L, Feng H, Hu M. Systematic assessment and quality evaluation of literatures on economic evaluation of diabetes drugs in Chinese population. China Pharmacy. 2022;33(10):1225-1232. [Chinese].
  19. Feng Y, Ke X, Tang W. Evaluation of the quality of Chinese literature in the pharmacoeconomic evaluation of antitumor drugs. China Journal of Pharmaceutical Economics. 2021;16(4):11-15.
  20. Heart Protection Study Collaborative Group. Statin cost-effectiveness in the United States for people at different vascular risk levels. Circ Cardiovasc Qual Outcomes. 2009;2(2):65-72. doi:1161/circoutcomes.108.808469
  21. Husereau D, Drummond M, Augustovski F, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 explanation and elaboration: a report of the ISPOR CHEERS II good practices task force. Value Health. 2022;25(1):10-31. doi:1016/j.jval.2021.10.008
  22. Pandey P, Pandey RD, Shah V. Evaluation of quality of pharmacoeconomic studies in Asia-Pacific region and identification of influencing variables. Value Health Reg Issues. 2018;15:70-75. doi:1016/j.vhri.2017.07.007
  23. Genuino AJ, Gloria MA, Chaikledkaew U, Reungwetwattana T, Thakkinstian A. Economic evaluation of adjuvant trastuzumab therapy for HER2-positive early-stage breast cancer: systematic review and quality assessment. Expert Rev Pharmacoecon Outcomes Res. 2021;21(5):1001-1010. doi:1080/14737167.2020.1819795
  24. Wang L, Shi F, Guan X, Xu H, Liu J, Li H. A systematic review of methods and study quality of economic evaluations for the treatment of schizophrenia. Front Public Health. 2021;9:689123. doi:3389/fpubh.2021.689123
  25. Liu G, Wu EQ, Ahn J, et al. The Development of Health Technology Assessment in Asia: Current Status and Future Trends. Value Health Reg Issues. 2020;21:39-44. doi:1016/j.vhri.2019.08.472
  26. Liu GG, Hu S, Wu J, et al. China Guidelines for Pharmacoeconomic Evaluations. Beijing: China Market Press; 2020.
  27. National Health Care Institute (NHCI). Guideline for Economic Evaluations in Healthcare 2016. https://tools.ispor.org/PEguidelines/source/Netherlands_Guideline_for_economic_evaluations_in_healthcare.pdf. Accessed March 23, 2024.
  28. Medicinrådet. The Danish Medicines Council Methods Guide for Assessing New Pharmaceuticals. 2021. https://medicinraadet.dk/media/wq0dxny2/the_danish_medicines_council_methods_guide_for_assessing_new_pharmaceuticals_version_1-2_adlegacy.pdf. Accessed March 23, 2024.
  29. Canadian Agency for Drugs and Technologies in Health (CADTH). Guidelines for the Economic Evaluation of Health Technologies: Canada. 2017. https://www.cda-amc.ca/sites/default/files/pdf/guidelines_for_the_economic_evaluation_of_health_technologies_canada_4th_ed.pdf. Accessed March 23, 2024.
  30. Indonesian HTA Committee Ministry of Health, Indonesia. Health Technology Assessment (HTA) Guideline. 2017. https://adphealth.org/upload/resource/FINAL_HTA_ENG_-1.pdf. Accessed March 23, 2024.
  • Receive Date: 17 June 2024
  • Revise Date: 12 February 2025
  • Accept Date: 09 March 2025
  • First Publish Date: 12 March 2025