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12!questions!to!help!you!make!sense!of!an! Three!broad!issues!need!to!be!considered!when!appraising!an! !!Is!the!economic!evaluation!valid?!! ! ! ! (Section!A)! !!How!were!consequences!and!costs!assessed!and!compared?! (Critical Appraisal Skills Programme)

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The 12!questions!to!help!you!make!sense!of!an! Three!broad!issues!need!to!be!considered!when!appraising!an! !!Is!the!economic!evaluation!valid?!! ! ! ! (Section!A)! !!How!were!consequences!and!costs!asses form is 6 pages long and contains:

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CASP!Checklist:
!
12!questions!to!help!you!make!sense!of!an!
Economic!Evaluation
!
How!to!use!this!appraisal!tool:!
Three!broad!issues!need!to!be!considered!when!appraising!an!
economic!evaluation!study:
!
!!Is!the!economic!evaluation!valid?!! ! ! ! (Section!A)!
!!How!were!consequences!and!costs!assessed!and!compared?! (Section!B)!
!!Will!the!results!help!in!purchasing!for!local!people?!! ! (Section!C)!
The!12!questions!on!the!following!pages!are!designed!to!help!you!think!about!these!issues!
systematically.!The!first!two!questions!are!screening!questions!and!can!be!answered!quickly.!
If!the!answer!to!both!is!“yes”,!it!is!worth!proceeding!with!the!remaining!questions.!There!is!
some!degree!of!overlap!between!the!questions,!you!are!asked!to!record!a!“yes”,!“no”!or!
“can’t!tell”!to!most!of!the!questions.!A!number!of!italicised!prompts!are!given!after!each!
question.!These!are!designed!to!remind!you!why!the!question!is!important.!Record!your!
reasons!for!your!answers!in!the!spaces!provided.!
About:
!These!checklists!were!designed!to!be!used!as!educational!pedagogic!tools,!as!part!of!a!
workshop!setting,!therefore!we!do!not!suggest!a!scoring!system.!The!core!CASP!checklists!
(randomised!controlled!trial!&!systematic!review)!were!based!on!JAMA!'Users’!guides!to!the!
medical!literature!1994!(adapted!from!Guyatt!GH,!Sackett!DL,!and!Cook!DJ),!and!piloted!with!
health!care!practitioners.!
For!each!new!checklist,!a!group!of!experts!were!assembled!to!develop!and!pilot!the!checklist!
and!the!workshop!format!with!which!it!would!be!used.!Over!the!years!overall!adjustments!
have!been!made!to!the!format,!but!a!recent!survey!of!checklist!users!reiterated!that!the!basic!
format!continues!to!be!useful!and!appropriate.!
Referencing:
!we!recommend!using!the!Harvard!style!citation,!i.e.:!Critical!Appraisal!Skills!
Programme!(2018).!CASP!(insert!name!of!checklist!i.e.!Economic!Evaluation)!Checklist.![online]!
Available!at:!!URL.!Accessed:!Date!Accessed.!
©CASP!this!work!is!licensed!under!the!Creative!Commons!Attribution!–!Non-Commercial-
Share!A!like.!To!view!a!copy!of!this!license,!visit!http://creativecommons.org/licenses/by-nc-
sa/3.0/!www.casp-uk.net!!
Critical Appraisal Skills Programme (CASP) part of Oxford Centre for Triple Value Healthcare Ltd www.casp-uk.net
2!
Section!A:!Is!the!econom ic!e v a lua tio n !valid?!
1. Was!a!well-defined!question
posed?
Yes!
HINT:!Is!it!clear!what!the!authors!are!trying!
to!achieve!
•
what!is!the!perspective
• How!many!options!are
compared!
•
are!both!costs!and!consequences
considered!
•
what!is!the!time!horizon
Can’t!Tell!
No!
Comments:!
2. Was!a!comprehensive
description!of!the!com peting
alternatives!given ?
Yes!
HINT:!is!there!a!clear!dec ision!tre e!(or!
similar!given):!
• can!you!tell!who!did!what,!to!whom,
where!and!how!often!
Can’t!Tell!
No!
Comments:!
Is!it!worth!c o ntin u ing ? !
Paper for appraisal and reference:
!!
!
!
3!
3. Does!the!paper!provide!
evidence!that!the!programme!
would!be!effective?!!
(i.e.!would!the !pro g ramme!do!
more!good!than!harm?)!
Yes!
!
!
HINT:!Consider:!
•
!if! a n !R C T!or!systematic!review!was!use d ;!
if!not,!co n s id e r !h o w!strong!th e !evidence!
was!(economic!evaluations!frequently!
have!to!integrate!diffe ren t!type s!of!
knowledge!stemming!from!different!
study!designs)!
!
Can’t!Tell!
!
!
No!!
!
!
Comments:!
!
!
!
!
!
4.!Were!the!effects!of!the!
interve n tion!identified ,!
measured!and!valued!
appropriately?!
Yes!
!
!
HINT:!Effects!can!be!measured!in!natural!
units!(e.g.!years!of!life)!or!more!complex!
units!(e.g.!years!adjusted!for!quality!of!life!
such!as!as!QALYS)!or!monetary!
equivalents!o f!the!benefit!gained!(e.g.!$)!
! !!
Can’t!Tell!
!
!
No!
!
!
!
!
!
Comments:!
!
!
!
!
Section!B:!How!were!consequences!and!costs!assessed!and!compared?!
!
!
5.!Were!all!important!and!
relevant!resource s!requ ired,!
and!health!outcome!costs!for!
each!alternative!identified,!
measured!in!appropriate!units!
and!valued!credibly?!
Yes!
!
!
HINT:!Iden tifie d ?!!!
•
!re member!the!perspe c tive !b e ing !tak e n !
HINT:!measured!accurately?!
• appropriate!units!may!be!hours!o f!
nursing!time,!number!of!physician!
visits,!years-of-life!gained!etc.!
HINT:!valued!credibly?!
• are!the!values!realistic!
• how!have!they!been!derived!
• have!opportunity!costs!been!
considered!
!
• !
• !
Can’t!Tell!
!
!
No!
!
!
!
!!
!
!
4!
Comments:!!
!
!
!
!
!
6.!Were!costs!and!consequences!
adjusted!for!different!times!at!
which!they!occurred!
(discounting )?!
Yes!
!
!!
Can’t!Tell!
!
No!
!
!
Comments:!
!
!
!
!
!
7.!What!were!the!results!of!the!
evaluation?!
Yes!
!
HINT:!Consider!!
•
what!is!the!bottom!line!
•
what!units!were!used!(e.g.!cost/life!
year!gained,!cost/QALY,!net!benefit)!
Can’t!Tell!
!
No!
!
!
!
!
!
!
Comments:!
!
8.!Was!an!incremental!analysis!of!the!
consequences!and!cost!of!
alternatives!performed?!
Yes!
!
!
!
Can’t!Tell!
!
!
No!
!
!
!
Comments:!
!
!
!
!
!
!!
!
!
5!
!
9.!Was!an!adequate!sensitivity!
analysis!performed?!
Yes!
!
!
HINT:!Consider!
• if!all!the!main!area s!o f!u nc ert ain ty!
were!considered!by!changing!the!
estimate!of!the!variable!and!
• looking !at!how!this!would!change!
the!result!of!the !eco nom ic!
evaluation!
Can’t!Tell!
!
!
No!
!
!
!
!
Comments:!!
!
!
!
!
Section!C:!Will!the! re s u lts !h e lp ! in !p u rc h a s in g !f o r! lo c a l!p e o p le?!
!
!
!
10.!Is!the!prog ra mme!likely!to!b e !
equally!effective!in!your!
context!or!setting?!
Yes!
!
!
HINT:!Consider!whether!
• the!patients!cov ere d!b y!the !rev iew !
could!be!sufficiently!different!to!your!
population!to!cause!concern!
• your!local!setting!is!likely!to!differ!much!
from!that!o f!the !re view !
!
Can’t!Tell!
!
!
No!
!
!
!
!
!
Comments:!
!
!
11.!Are!the!costs!translatable!to!
your!setting?!
Yes!
!
!
!
Can’t!Tell!
!
!
No!
!
!
!
!
!
Comments:!
!
!
!!
!
!
6!
12.!Is!it!worth!d o ing !in!y o u r!
setting?!
Yes!
!
!
!
Can’t!Tell!
!
!
No!
!
!
!
Comments:!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
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12questionstohelpyoumakesenseofan Threebroadissuesneedtobeconsideredwhenappraisingan Istheeconomicevaluationvalid (SectionA) Howwereconsequencesandcostsassessedandcompared (Critical Appraisal Skills Programme)

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