CREST has developed a number of resources to assist the CTGs to incorporate health economic and pharmacoeconomic analyses into trial protocols, as well as to build capacity for health economics within the CTGs.
Conducting an economic evaluation: proforma documents
Over the years, CREST has developed and provided a number of documents on the why and how of conducting an economic evaluation alongside a cancer clinical trial. While some documents have provided background information on health economics concepts, others have been more applied in nature, focusing on collecting data for economic evaluation.
Now, all those documents can be accessed through one portal on the CREST website.
The aim of the portal is to allow CTGs intending to include health economics in a clinical trial to have (a) some initial starting guidance on how to conceptualise the problem, (b) guidance to determine whether health economics needs to be considered, (c) an outline of how to collect the relevant data, and (d) access to example questions for data collection that can be included in study case-report-forms (CRFs).
The resources available in this section of the portal aim to provide background on the concepts of health economics and the conduct of an economic evaluation alongside a clinical trial. This not only includes a step-by-step guide to conducting an economic evaluation, but the resources required to conduct such an evaluation. The documents available include:
- Economic evaluations in cancer clinical trials (factsheet). This provides general guidance on understanding the purpose of conducting an economic evaluation.
- Health economic checklist of clinical trials (checklist). This provides questions to determine whether the study may require a health economics audit by CREST.
- Step-by-step guide to economic evaluations in clinical trials (factsheet). This provides an overview of the steps involved in undertaking an evaluation.
- How much does it cost to include an economic evaluation in a clinical trial (factsheet). This provides the developers of trials with a practical understanding of what is required when considering the budget for an economic evaluation.
Collecting the data
Over the years, CREST has provided advice on the choice and development of questions to collect resource use (cost) and outcomes data from clinical trials. The advice provided has been summarised, in a de-identified manner, into a proforma document (in Excel) that contains example questions on collecting information within clinical trials on the following:
- Treatment use and follow-up services (including medical and diagnostic services use)
- Hospital services use
- Treatment of adverse events
- Patient-reported outcomes: quality of life and other PROs
- Demographic information
In general, the questions contained in this workbook can be customised (unless stated otherwise in the workbook); please ask one of the members of CREST if you need further advice.
Alongside that workbook, CREST has also provided information on collecting administrative data (data on patients’ health care use that are collected as part of the routine process of paying for health care services). The Medicare Australia Data (factsheet) provides general guidance on the rationale and process for accessing Medicare (MBS and PBS) data. Accessing data from Medicare requires not only patient consent but an application to the Department of Human Services. If you would like assistance in completing that application, or to see an example application form, please contact CREST.
How to estimate QoL scores for health economics analysis
A critical step in using health-related quality of life data within economic evaluations is being able to convert patient-rated health status into society-rated preference values, or utility weights. The instructions and code required for the conversion of EQ-5D quality of life data into preference weights are available as a CREST factsheet. In due course, additional algorithms will be added for the conversion of the SF-6D and the EORTC QLQ-C30 into utility values.
Factsheets and templates
To aid the CTGs in developing a protocol to include an economic evaluation alongside a clinical trial, a standard proforma has been developed. This proforma includes key issues for consideration, key questions and options, essential data items, identification of data sources, ethics requirements for collection of economics data, and standard forms for data collection from a range of sources.
- Command Files to Generate EQ-5D Weights for Australia — EQ-5D TTO DCE Weights
- Command Files to Generate EQ-5D Weights for Australia — EQ-5D-5L Scores
- Costing an economic evaluation
- Discounting in Economic Evaluations in Health Care: A Brief Review
- Economic evaluations in cancer clinical trials — why would I do an economic evaluation as part of my clinical trial?
- Health-related quality of life for economic evaluations in cancer — why do clinical trials need economic evaluation-specific quality of life measures?
- How oncology studies obtain QALY weights: a literature review
- Medicare Australia data for research: an introduction
- Productivity losses and how they are calculated
- Sample size calculation in economic evaluation
- Step by step guide to economic evaluation in cancer trials
- Translating Clinical Trial Data for use in an Economic Evaluation
As part of its capacity-building services for the Cancer Australia Collaborative Clinical Trials Groups (CTGs), CREST holds several health economics focused workshops each year.
Members of CTGs can access the material discussed at workshops; each workshop has been provided as a series of short videos produced from the material presented.
Topics currently available on the web- site include:
- Understanding health economics in cancer research
- Preferences in Cancer Trials – What Choices can tell us About Value
- Health Economics in Cancer Research – A Consumers’ Guide
Other health economics and health services research associations
- Academy Health (open an external site)
- Australian Health Economics Society (AHES) (open an external site)
- Health Services Research Association of Australia & New Zealand (HSRAANZ) (open an external site)
- International Health Economics Association (iHEA) (open an external site)
- Australian Research Council (ARC) (open an external site)
- Australian Resource Centre for Hospital Innovation (ARCHI) (open an external site)
- Canadian Coordinating Office for Health Technology Assessment (open an external site)
- Cancer Australia (open an external site)
- Cochrane Collaboration (open an external site)
- Cochrane Consumers and Communication Review Group (open an external site) La Trobe University
- Consumers' Health Forum of Australia (open an external site)
- Cooperative Research Centre for Asthma (open an external site)
- Department of Health (open an external site)
- European Organization for Research and Treatment of Cancer (EORTC) (open an external site)
- Health Policy Monitor — International Network for Health Policy & Reform (open an external site)
- Institute of Health Economics (open an external site) Edmonton, Canada
- Medical Research Future Fund (MRFF) (open an external site)
- National and Health Medical Research Council (NMRC) (open an external site)
- National Breast Cancer Centre (open an external site)
- National Institute of Clinical Studies (open an external site)
- NHS Centre for Reviews and Dissemination (open an external site)
- NSW Cancer Council (open an external site)
- School of Public Health (open an external site) The University of Sydney
- US National Library of Medicine (open an external site)
Data and methods
- Centre for Health Record Linkage (CheRel) (open an external site)
- Population Health Research Network (PHRN) — Australian Data Linkage Units (open an external site)
Journals and newsletters
- Applied Health Economics and Health Policy (open an external site)
- British Medical Journal (BMJ) (open an external site)
- The Economic Record (open an external site)
- European Journal of Health Economics (open an external site)
- Health Economics (open an external site)
- Health Policy (open an external site)
- Health Services Research Journal (open an external site)
- Journal of Health Economics (open an external site)
- Journal of Health Services Research & Policy (open an external site)
- Medical Journal of Australia (MJA) (open an external site)
- Pharmacoeconomics (open an external site)
- Quality of Life Research (open an external site)
- Scandinavian Working Papers in Economics (open an external site)
- Social Science and Medicine (open an external site)
- Value in Health (open an external site)
- Department of Health (open an external site)
- Department of Human Services, Victoria (open an external site)
- ACT Health (open an external site)
- QLD Health (open an external site)
- WA Health (open an external site)
- SA Health (open an external site)
- NSW Health (open an external site)
- NT Health (open an external site)
- Tasmania Health (open an external site)
Information about health and health care in Australia
- Australian Bureau of Statistics (ABS)
- Australian Institute of Health and Welfare (AIHW)
- Australian Prudential Regulation Authority (APRA) for private health insurance (open an external site)
- Independent Hospital Pricing Authority (IHPA)
- Medicare Australia statistics
Research funding bodies
- Australian Research Council (open an external site)
- Medical Research Future Fund (MRFF) (open an external site)
- National Health and Medical Research Council (open an external site)
Useful journal articles
- Phillips et al. 2018, ‘Methodological Issues in Assessing the Economic Value of Next-Generation Sequencing Tests: Many Challenges and Not Enough Solutions’, Value Health, vol. 21, no. 9, pp. 1033–1042
- King et al. 2018, ‘Australian Utility Weights for the EORTC QLU-C10D, a Multi-Attribute Utility Instrument Derived from the Cancer-Specific Quality of Life Questionnaire, EORTC QLQ-C30’, Pharmacoeconomics, vol. 36, no. 2, pp. 225–238.
- Huang et al. 2018, ‘Life satisfaction, QALYs, and the monetary value of health’, Social Science & Medicine, vol. 211, pp. 131–136.
- van Sambeek et al. 2018, ‘Comparing the cost of preparing matched unrelated donor and TCR α+β+/CD19+ depleted donor material for pediatric hematopoietic stem cell transplants in Australia’, Pediatric Transplantation, vol. 22, no. 7, p. e13279
- Wang et al. 2018, ‘A Generic Model for Follicular Lymphoma: Predicting Cost, Life Expectancy, and Quality-Adjusted-Life-Year Using UK Population–Based Observational Data’, Value in Health, vol. 21, no. 10, pp. 1176–1185
- Pearce et al. 2018, ‘Productivity losses due to premature mortality from cancer in Brazil, Russia, India, China, and South Africa (BRICS): A population-based comparison’, Cancer Epidemiology, vol. 53, pp 27–34
- Santos et al. 2018, ‘Cost-effectiveness thresholds: methods for setting and examples from around the world’, Expert Review of Pharmacoeconomics & Outcomes Research, vol. 18, no. 3, pp 277–288.
- The Conversation Media Group Ltd 2017, We don’t need to change how we subsidise ‘breakthrough’ cancer treatments, viewed 21 January 2019
- Bien et al. 2017, ‘Patients’ Preferences for Outcome, Process and Cost Attributes in Cancer Treatment: A Systematic Review of Discrete Choice Experiments’, Patient, vol. 10, no. 5, pp 553–565
- Morrell et al. 2017, ‘Does the Public Prefer Health Gain for Cancer Patients? A Systematic Review of Public Views on Cancer and its Characteristics’, Pharmacoeconomics, vol. 35, no. 8, pp. 793–804
- Nerich et al. 2017, ‘Critical appraisal of health-state utility values used in breast cancer-related cost–utility analyses’, Breast Cancer Research and Treatment, vol. 164, no. 3, pp. 527–536
- Nerich et al. 2016, ‘Cost-utility analyses of drug therapies in breast cancer: a systematic review’, Breast Cancer Research and Treatment, vol. 159, no. 3, pp. 407–424
- Schiller-Fruhwirth et al. 2017, ‘Cost-effectiveness Models in Breast Cancer Screening in the General Population: A Systematic Review’, Applied Health Econ Health Policy, vol. 15, no. 3, pp. 333–351
- Phillips, K. 2017, ‘Assessing the value and implications of personalized/ precision medicine and the "lessons learned" for emerging technologies: An introduction’, Value in Health, vol. 20, no. 1, pp 30–31
- Garrison, L., Kamal-Bahl, S. & Towse, A. 2017, ‘Toward a broader concept of value: Identifying and defining elements for an expanded cost-effectiveness analysis’, Value in Health, vol. 20, no. 2, pp. 213–216
- Marshall D, Gonzalez J, MacDonald K, et al. ‘Estimating preferences for complex health technologies: Lessons learned and implications for personalized medicine’. Value in Health, vol. 20, no. 1, pp. 32–39
- Hernandez-Villafuerte, K., Fischer, A. & Latimer, N. 2018, ‘Challenges and Methodologies in Using Progression Free Survival as a Surrogate for Overall Survival in Oncology’, International Journal of Technology Assessment in Health Care, vol. 34, no. 3, pp 300–316