Evaluation of Evidence in Economic Models Used for Decision-Making: Development of the Data Inputs in Value Economic Evaluations (DIVEE) Checklist

Abstract

Background: Value or health technology assessment (V/HTA) is a structured approach for evaluating health interventions to inform coverage and reimbursement decisions. V/HTAs often include model-based economic evaluations (economic models) to gauge economic value. Economic models formally examine costs and consequences of interventions versus alternatives.

Data sources and inputs (DSIs) used to populate economic models influence the findings, and inappropriate DSIs can result in misleading economic value appraisals. Thus, it is important health care decision-makers (HCDMs) assess the appropriateness of DSIs used to populate key economic-model parameters to understand whether the model is suitable for use in their decision-making. But many HCDMs lack economic training and may be ill-prepared for assessing DSIs. A tool is needed to help HCDMs efficiently and confidently assess DSIs used in economic models to support informed decision-making. Objective: Create a user-friendly checklist that supports HCDMs in assessing, in a standardized, clear, and consistent manner, the appropriateness of DSIs used in model-based V/HTA economic evaluations.

Methods: A checklist was developed in three stages: 1. Need for a checklist was established through assessment of DSIs used in published V/HTA economic model reports and a search for existing guidance on identifying, selecting, or reporting DSIs for economic evaluations. 2. Stakeholder perspectives on evaluation of DSIs were obtained through interviews and applied, along with findings from the previous stage, to create, test, and refine a checklist. 3. HCDM views on the new checklist and its potential use in decision-making were elicited through case reviews and interviews.

Findings: The Data Inputs in Value Economic Evaluations (DIVEE) Checklist is comprised of eleven items organized into four domains (transparency, relevance, credibility, and model robustness). HCDMs report the Checklist to be comprehensive, easy to understand, and a useful aid for evaluating economic models. HCDMs support use of the Checklist, but recognize barriers exist to full adoption in current decision-making processes.

Conclusions: The DIVEE Checklist is a user-friendly decision-maker aid that facilitates transparent, systematic, and consistent assessment of DSIs used in economic models and, ultimately, better-informed coverage and reimbursement decisions. Further testing in larger groups of HCDMs is needed along with training and educational support.