Incorporation of Brief Economic Commentaries into Cochrane Incontinence Group Intervention Reviews

by Patricia Aluko

There are two methodological frameworks for incorporating economic evidence into Cochrane intervention reviews, these are an integrated full systematic review of economic evidence and Brief Economic Commentaries (BECs). The UK National Institute for Health Research funded the incorporation of BECs into eight Cochrane Incontinence Group intervention reviews. These eight reviews each focused on different surgical approaches to treat stress urinary incontinence in women.

The included reviews for the project were:

I.        Anterior vaginal repair for urinary incontinence in women
II.      Bladder neck needle suspension for urinary incontinence in women
III.    Open retropubic colposuspension for urinary incontinence in women
IV.     Laparoscopic colposuspension for urinary incontinence in women
V.      Traditional suburethral sling operations for urinary incontinence in women
VI.     Mid-urethral sling operations for stress urinary incontinence in women
VII.    Single-incision sling operations for urinary incontinence in women
VIII.  Urethral injection therapy for urinary incontinence in women

These reviews were chosen because surgery for stress urinary incontinence and in particular the use of synthetic mesh in some of these surgical procedures has been the subject of much debate both in the UK and internationally. Concerns about the safety of the use of a synthetic mesh used in some forms of surgery have been expressed. Given these concerns attention has returned to the use of alternative procedures both in terms of their effectiveness and cost-effectiveness.

The ‘brief economic commentary’ framework is specifically designed to support the inclusion of an economic perspective and evidence in Cochrane intervention reviews without requiring specialist input from health economists (beyond initial guidance and training in the method and procedures), and without placing a major additional workload burden on author teams. This framework can be viewed as a ‘minimal framework’ for incorporating economic perspectives and evidence, with inherent limitations that will require appropriate caveats in the commentary. The commentaries are included in the background and discussion section of a Cochrane intervention review.

For this project, we identified relevant cost-of-illness studies for the background section of each intervention review to estimate the economic burden of urinary incontinence in different countries. This included the economic burden of the urinary incontinence to health care systems, patients, their families and society as a whole. For the discussion section of the review, we identified all relevant economic evaluations using the NHS EED, MEDLINE and Embase databases (on OvidSP).

The information in the discussion section included: number and type of economic evaluations included in the review; whose costs and whose benefits were considered and over what time. As studies could be conducted in a variety of different countries and at different times, information on the currency and price year were also reported. Finally, the principal conclusions – as made by the authors of the identified studies – were summarised along with any caveats around these conclusions. The full list of the eight published reviews including a Brief Economic Commentary can be viewed on the Cochrane Incontinence Group’s news page.

Brief Economic Commentaries are only intended to highlight the existence of economic evidence. One important limitation of the approach is that the evidence is not subjected to formal critical appraisal. For that reason, readers are advised to be cautious when interpreting the economic evidence. Nevertheless, the BEC approach is a practical and simple method that can be completed without placing too much additional burden on the review authors’ team.