Table 7.

Quality of health economic studies framework

Number	Question text	Scoring
1	Was the study objectively presented in a clear, specific and measurable manner?	Clear, specific, measurable = 7 Any two = 5 Any one = 2 None = 0
2	Was the perspective of the analysis (societal, third party, payer, etc.) and reasons for its selection stated?	Perspective = 2 Reasons = 2 Both = 4
3	Were variable estimates used in the analysis from the best available source (i.e. randomised control trial—best, expert opinion—worst)?	Randomised control trial = 8 Non-randomised control trial = 7 Cohort studies = 6 Case-control/case report/case series = 4 Expert opinion = 2
4	If estimates came from a subgroup analysis, were the groups prespecified at the beginning of the study?	Yes = 1 No = 0
5	Was uncertainty handled by (1) statistical analysis to address random events, (2) sensitivity analysis to cover a range of assumptions?	Statistical analysis = 4.5 Sensitivity analysis = 4.5 Both = 9
6	Was incremental analysis performed between alternatives for resources and costs?	Yes = 6 No = 0 CCA type of economic evaluation = NA
7	Was the methodology for data extraction (including the value of health states and other benefits) stated?	Yes = 5 No = 0
8	Did the analytic horizon allow time for all relevant and important outcomes? Were benefits and costs that went beyond 1 year discounted (3% to 5%) and justification given for the discount rate?	(1) Time horizon = 3 (2) Cost discounting = 1 (3) Benefit discounting = 1 (4) Justification = 2 All but justification = 5 All = 7
9	Was the measurement of costs appropriate and the methodology for the estimation of quantities and unit costs clearly described?	(1) Appropriateness of cost measurement = 4 (2) Clear description of methodology for the estimation of quantities = 2 (3) Clear description of methodology for the estimation of unit costs = 2 All = 8
10	Were the primary outcome measure(s) for the economic evaluation clearly stated and did they include the major short-term? Was justification given for the measures/scales used?	(1) Primary outcome clearly stated = 2 (2) Include major short-term outcome = 2 (3) Justification = 2 All = 6
11	Were the health outcomes measures/scales valid and reliable? If previously tested valid and reliable measures were not available, was justification given for the measures/scales used?	Yes = 7 No = 0
12	Were the economic model (including structure), study methods and analysis and the components of the numerator and denominator displayed in a clear, transparent manner?	(1) Economic model = 2 (2) Study methods = 1.5 (3) Analysis = 1.5 (4) Components of numerator = 1.5 (5) Components of denominator = 1.5 All = 8 If not a modelling study, done for (1) Study methods = 2 (2) Analysis = 2 (3) Components of numerator = 2 (4) Components of denominator = 2 All = 8
13	Were the choice of economic model, main assumptions and limitations of the study stated and justified?	(1) Economic model = 2 (2) Assumptions = 2.5 (3) Limitations = 2.5 All = 7 If not a modelling study, done (stated and justified) for (1) Assumptions = 3.5 (2) Limitations = 3.5 Both = 7
14	Did the author(s) explicitly discuss direction and magnitude of potential biases?	(1) Direction = 3 (2) Magnitude = 3 Both = 6
15	Were the conclusions/recommendations of the study justified and based on the study results?	Yes = 8 No = 0
16	Was there a statement disclosing the source of funding for the study?	Yes = 3 No = 0