Chapter 5Cost-effectiveness review
Methods of cost-effectiveness review
The systematic review was conducted using methods in line with those recommended in the CRD guidance for undertaking reviews in health care20 and the Cochrane Handbook for reviews of intervention studies.21
Inclusion and exclusion criteria
Population
Studies including adult patients who were eligible for fEVAR (aged ≥ 18 years) with JRAAAs or eligible for bEVAR with TAAAs, i.e. with proximity to, or involvement of, target vessels such that EVAR was unsuitable.
Intervention
fEVAR and bEVAR.
Comparator (clinical effectiveness studies only)
OSR or no surgery for patients considered unsuitable for OSR.
Outcomes
Cost-effectiveness.
Health-care cost.
Social care costs.
Search strategy
Search strategies were based on the target conditions, JRAAAs and TAAAs. Searches were not limited by language or publication status (unpublished or published). Resources were searched to identify cost-effectiveness studies of treatments for JRAAAs and TAAAs. Where appropriate, strategies incorporated a cost-effectiveness search filter. Full strategies for the cost-effectiveness searching are presented in Appendix 1. The following resources were searched from inception:
MEDLINE (OvidSP). Searched 1946 to week 3 September 2013.
MEDLINE In-Process & Other Non-Indexed Citations (OvidSP). Searched up to 1 October 2013.
MEDLINE Daily Update (OvidSP). Searched up to 1 October 2013.
EMBASE (OvidSP). Searched 1974 to 27 September 2013.
NHS EED (Wiley). Searched issue 3: 2013.
EconLit (EBSCOhost). Searched up to 30 September 2013.
Screening strategy
Titles and abstracts of all reports identified by the searches were screened by one reviewer and ambiguities were resolved by consulting a second reviewer. Full copies of all studies deemed potentially relevant were obtained and were assessed by one reviewer for inclusion; any ambiguities were resolved by consulting a second reviewer.
Methods of analysis/synthesis
Given that no studies met all of the inclusion criteria, a narrative account of the number of studies screened for inclusion and reasons for excluding studies was given.
Results of cost-effectiveness review
Summary of inclusion/exclusion
The health economics search identified 104 references before deduplication. Owing to overlap between the databases, 34 duplicate records were removed. The remaining 70 records were screened. Of these, seven were included for the full assessment based on initial screening. After full-text review no studies were included, as presented in . Six of these seven studies estimated the cost-effectiveness of EVAR compared with OSR for patients with a pararenal AAA who were defined as unsuitable for EVAR25,34–38 and, thus, these studies were excluded based on the population. Furthermore, five of them,34–38 were presented at conferences, and these abstracts were not presented in such a way that data could be extracted from it. The other study39 reported costs of fEVAR, but this was reported without sufficient details and in Canadian dollars.
Flow of studies through the screening process: cost-effectiveness review.
