HEALTH TECHNOLOGY ASSESSMENT evaluation guidelines into one current, useful reporting

FINALS guidance.
“Consolidated Health Economic Evaluation Reporting
APPRAISING TOOLS FOR ECONOMIC EVALUATION Standards 2022 (CHEERS 2022) Explanation and
Elaboration: A Report of the ISPOR Economic Evaluation
Health Technology Assessment (HTA) is the systematic Guidelines Good Research Practices Task Force II”
evaluation of properties, effects, and/or impacts of describes reporting guidance in detail. CHEERS 2022
health care technology. It should include medical, social, includes a 28-item checklist that outlines how and when
ethical, and economic dimensions, and its main purpose these reporting standards should be used.
is to inform decision-making in the health area. These
assessments look at benefits and efficacy, clinical and The report describes:
technical safety, and cost-effectiveness. Informed 1. the rationale behind each reporting item
decision-making comprises issues surrounding coverage recommendation with supporting evidence (if
and reimbursement, pricing decisions, clinical guidelines available),
and protocols, and lastly, medical device regulation. The 2. accompanying example(s) to illustrate and
facilitate its appropriate use
main purpose of HTA is to inform a policy decision
3. a description and an explanation of why it is
making in health care, and thus improve the uptake of
important for interpreting published economic
cost-effective new technologies and prevent the uptake evaluations.
of technologies that are of doubtful value for the health
system.
HTA is used to define which benefits to include while Why it is Important
carrying out evidence-based assessments. New
technologies are usually costlier than older ones and Economic evaluations of health interventions are
contribute to rising health expenditures. In this context, comparative analyses of alternative courses of action in
the HTA process ensures that new technology is not terms of their costs and consequences. They can
added until it is proven to be effective. HTA is also provide valuable information to policy makers, payers,
concerned with quality, and the role of new health professionals, patients, and the public about
technologies to improve health outcomes. choices that affect health and the use of resources.
The basic principle behind economic evaluation is the The CHEERS 2022 Good Practices Report provides
examination of the costs and outcomes associated with healthcare stakeholders with guidance and a checklist to
each of the options being considered to determine if improve reporting. This will help authors provide
they are worth the investment. accurate information on which health interventions are
Economic evaluation is a comparative analysis of at least being compared and in what context, how the
two health interventions used to assess both the costs evaluation was undertaken, what the findings are, and
and consequences of the different technologies in a other details that may aid readers and reviewers in
given population, providing a decision framework. The interpretation and use of the study.
two main components of this analysis are ‘costs’ and
‘outcomes’ CHEERS 2022 CHECKLIST

Item Guidance for Reporting

Introduction CHEERS Statement TITLE
Title 1 Identify the study as an
The statement was developed by a task force supported
economic evaluation and
by the International Society for Pharmacoeconomics
specify the interventions being
and Outcomes Research (ISPOR), as part of a broader
compared.
initiative to facilitate and encourage the interchange of ABSTRACT
expert knowledge and develop best practices. Abstract 2 Provide a structured summary
The Consolidated Health Economic Evaluation that highlights context, key
Reporting Standards (CHEERS) statement is an attempt methods, results and
to consolidate and update previous health economic alternative analysis.
INTRODUCTION analytic model used. Providing
Background 3 Give the context for the study, a figure to show model
and objectives the study question and its structure is strongly
practical relevance for decision recommended.
making in policy or practice. Analytics and 17 Describe any methods for
METHODS assumptions analyzing or statistically
Health 4 Indicate whether a health transforming data, any
economic economic analysis plan was extrapolation methods, and
analysis plan developed and where available. approaches for validating any
Study 5 Describe characteristics of the model used.
population study population (such as age Characterizing 18 Describe any methods used for
range, demographics, heterogeneity estimating how the results of
socioeconomic, or clinical the study vary for sub-groups.
characteristics). Characterizing 19 Describe how impacts are
Setting and 6 Provide relevant contextual distributional distributed across different
location information that may influence effects individuals or adjustments
findings. made to reflect priority
Comparators 7 Describe the interventions or populations.
strategies being compared and Approach 20 Describe methods to
why chosen. uncertainty characterize any sources of
Perspective 8 State the perspective(s) uncertainty in the analysis.
adopted by the study and why
chosen. (20.a) Single study–based
Time horizon 9 State the time horizon for the economic evaluation: Describe
study and why appropriate. the effects of sampling
Discount rate 10 Report the discount rate(s) and uncertainty for estimated
reason chosen. incremental cost, incremental
Selection of 11 Describe what outcomes were effectiveness, and incremental
outcomes used as the measure(s) of cost-effectiveness, together
benefit(s) and harm(s). with the impact of
Measurement 12 Describe how outcomes used methodological assumptions
of outcomes to capture benefit(s) and (such as discount rate, study
harm(s) were measured. perspective)
Valuation of 13 Describe the population and (20.b) Model-based economic
outcomes methods used to measure and evaluation: Describe the
value outcomes. effects on the results of
Measurement 14 Describe how costs were uncertainty for all input
and valuation valued. parameters, and uncertainty
of resources related to the structure of the
and costs model and assumptions.
Currency, price 15 Report the dates of the Approach to 21 Describe any approaches to
date, and estimated resource quantities engagement engage patients or service
conversion and unit costs, plus the with patients recipients, the general public,
currency and year of and others communities, or stakeholders
conversion. affected by the (e.g., clinicians or payers) in the
Rationale and 16 If modelling is used, describe in study design of the study.
description of detail and why used. Report if RESULTS
model the model is publicly available Study 22 Report all analytic inputs (e.g.,
and where it can be accessed. parameters values, ranges, references)
including uncertainty or
Describe and give reasons for distributional assumptions.
the specific type of decision- Summary of 23 Report the mean values for the
main results main categories of costs and  Patient education to improve medication taking
outcomes of interest and behaviors
summarize them in the most  Drug use monitoring and review to ensure the
appropriate overall measure. appropriate use of medication
Effect of 24 Describe how uncertainty
uncertainty about analytic judgments, The federal government as well as the Medicare has
inputs, or projections affect
recognized the importance of implementation of MTM
findings. Report the effect of
especially for high-risk patients.
choice of discount rate and
time horizon, if applicable.
Effect of 25 Report on any difference Medication Therapy Management (MTM)
engagement patient/service recipient, MTM includes a broad range of professional activities
with patients general public, community, or and may occur in conjunction with or independently
and others stakeholder involvement made from the dispensing of a medication.
affected by the to the approach or findings of Core elements:
study the study.  Medication therapy review
DISCUSSION  A personal medication records
Study findings, 26 Report key findings, limitations,  A medication action plan
limitations, ethical or equity considerations  Intervention and referral
generalizability, not captured, and how these
 Documentation and follow-up
and current could impact patients, policy, or
knowledge practice.
Pharmacoeconomics
OTHER RELEVANT INFORMATION
Source of 27 Describe how the study was has been defined as “the description and analysis of the
funding funded and any role of the costs of drug therapy to healthcare systems and
funder in the identification, society”. It identifies, measures, and compares costs
design, conduct, and reporting (resources consumed) and consequences (clinical,
of the analysis. economic, humanistic) of pharmaceutical products and
Conflicts of 28 Report authors conflicts of
services.
interest interest according to journal or
International Committee of
Pharmacoeconomic studies weigh the cost of
Medical Journal Editors
requirements. alternative drugs and drug regimens against the
outcomes they achieve to guide decisions and policies
about which drugs should be used in general, which
PHARMACOECONOMICS IN PHARMACY SETTINGS drugs should be paid for by the government or other
third-party payers.

Pharmacy Services Pharmacoeconomics attempts to find out whether the

A variety of terms have been associated with added benefit of one intervention is worth the added
pharmaceutical or pharmacy services in the literature, cost of that intervention.
including clinical pharmacy services, cognitive pharmacy
services, pharmaceutical care services, disease state Pharmacoeconomics can be regarded as a branch of
management, and medication therapy management health economics which deals with identifying,
(MTM). measuring, and comparing the costs and consequences
Pharmacy services consist of a variety of functions of pharmaceutical products and services. It helps in
performed by a pharmacist that may or may not be forming an economic relationship which combines the
associated with the dispensing of a particular drug research, its production and distribution, storage,
prescription order. pricing, and further use by the people. Some of the
 Pharmacokinetic monitoring concepts/types involved in pharmacoeconomic analysis
include cost minimization, cost effectiveness, cost Economic Evaluation Reporting Standards (CHEERS)
benefit, and cost utility analysis. statement.

Pharmacoeconomics can help in decision-making when A variety of approaches have been used, includes:
evaluating the affordability of and access to the right  Contingent valuation (CV)
medication to the right patient at the right time when  Prospective studies
comparing two drugs in the same therapeutic class of  Modeling
drugs.  Willingness-to-pay
 Combination of these methods
Pharmacoeconomics in Pharmacy Services

The field of pharmacy practice experienced several

transformations – pharmacists have gone from mainly Pharmacoeconomics
performing medication dispensing activities to offering
individualized specialized care as part of healthcare
teams. These innovations in pharmacy practice services
identifies, measures,
and the pharmacy professionals who provide those
services are now recognized as a key resource of the
and compares the
healthcare system for the promotion of safe and rational
use of drugs. Such service innovations usually include costs and
complex multidimensional interventions provided
through educational, attitudinal, or behavioral actions. consequences of
Pharmacoeconomics is the branch of health economics
that focuses on weighing the costs and benefits of a
drug therapy to
particular intervention in comparison with an analogous
alternative. The goal is maximizing value for patients, healthcare systems
healthcare payers and society in light of increasingly
scarce resources. Thus, decisions-makers (e.g.,
healthcare professionals) have to consider whether or
and society.
not the new intervention is both affordable and an
efficient use of limited resources. Due to the high
One of the primary applications of pharmacoeconomics
in clinical practice is to guide clinical and policy decision
pricing of drug, it is
making. Pharmacists are increasingly providing services
intended to facilitate patients’ access to care and
very essential in
improve health and medication use and outcomes.
Many of today’s pharmacists provide a broad range of pharmaceutical
non-dispensing services such as vaccinations,
coordination and review of medications, management
of chronic diseases, prevention and wellness programs,
industry,
point-of care testing.
government, and in
The Professional Society for Health Economics and
Outcomes Research (ISPOR) is responsible for creating
guidelines for the conduction and reporting of
the private sector for
pharmacoeconomic studies— the Consolidated Health
comparing
various cost criterion for decision
consequences. This making in modern
branch of health health care policy.
care economics Pharmacoeconomics
offers important identifies, measures,
guidance for the and compares the
management of costs and
limited consequences of
health care drug therapy to
resources and healthcare systems
medical practice. and society.
As a consequence Due to the high
of limited financial pricing of drug, it is
resources, health very essential in
economics, and pharmaceutical
particularly industry,
pharmacoeconomic government, and in
analyses, are the private sector for
becoming a comparing
frequently used
various cost criterion for decision
consequences. This making in modern
branch of health health care policy.
Other researchers have used the approach of measuring
care economics how much money would hypothetically be saved in
direct medical costs when the community pharmacists

offers important performed interventions (e.g., detecting a drug-drug

interaction or a pre-existing allergy to the medication)

guidance for the before dispensing medications.

management of Importance of Pharmacoeconomics in Pharmacy

Practice

limited 

Individual patient level
Group of patients locally

health care  Larger group of patients

resources and
Individual Patient Level
 Healthcare professionals can determine the best
medication (treatment) for each patient. depending
medical practice. on demographic,
considerations.
clinical, and economic

As a consequence  Example: If a new branded medication is approved by

the FDA that has an advantage over another
marketed medication that is less expensive, the
of limited financial professional can take this into account.
 If the advantage is slight (e.g., more convenient once-
resources, health a-day dosing compared with twice-a-day dosing of its
competitor), the patient might not value the added

economics, and convenience at 350 per month.

 But if the advantage is a reduction in side effects
(e.g., no diarrhea or n daytime drowsiness), the
particularly added advantage may be worth the added cost
(willingness to pay).

pharmacoeconomic Group of Patients Locally

analyses, are  If a healthcare institution or community pharmacy

wanted to implement a clinical pharmacy service, or
hire a clinical pharmacist, they would look at the
becoming a costs and compare them with the values of providing
these services.

frequently used  The value of the services could be measured as

profit, as improved patient outcomes that decrease
the need for other costly services (e.g. medication
 management of diabetes to reduce diabetes-related  Ensure effective exchange of information
emergency room visits and hospitalizations), or as between the patient and the doctor →
better quality of care. professionally communicate what is written on
the prescription to the patient.
Larger Group of Patients  Highlight important points that the patient need
 Teams of professionals collaborate to determine the to do
most effective and cost-effective options for their  Situation: erroneous or impossible prescription
patient population. They develop drug use guidelines and the patient is already tired going to
(e.g., more expensive medication not recommended different pharmacies because they do not
for insurance coverage unless less expensive understand what is written on the prescription
medication is tried first) and determine what (telling the patient, for example, they do not
medications will be listed on their formulary and at have that certain medicine instead) → check
what co-payment level. with the doctor (call)
 For example, patients in a hospital system, managed
care organization, or government plan. Each group is 4. Leader
responsible for a specific patient population.  Whether the pharmacist finds him/herself in
multidisciplinary caring situations
 We are the one expert in demonstrating and
Pharmacists in Real World Setting creating high-performance pharmacy practices
such as medication management
 Summarized role of a pharmacist from WHO, FIP
 In community and hospital pharmacy → we are
(International Pharmaceutical Federation)
the leader, standard, and/or role model of our
pharmacy assistants when it comes to the
10 Star Pharmacist:
improvement of observing, medication safety,
1. Caregiver
patient care, and productivity
 The pharmacist provides caring services
 Show duties and responsibilities
 We have to care for our patients (we are not
just after the business)
5. Manager
 Genuine care should be shown and practiced.
 The pharmacist must effectively manage
resources and information
2. Decision-maker
 When we apply in community pharmacies, we
 The appropriate, efficacious, and cost-effective
are not in a rank and file staff, but instead, are
use of resources
already supervisor or manager → oversee the
 When it comes to medicine policy, both in local
whole pharmacy and staff
and national level, we play a vital role when it
 Deal with financial resources (budget,
comes to decision-making
purchases, miscellaneous)
 As a pharmacist, you must have the ability to
evaluate, synthesize, read, and interpret data
6. Life-long learner
and graphs → you have to continuously educate
 The concepts, principles, and commitment to
and train yourself by attending a lot of
life-long learning must begin with attending
webinars, seminars, and trainings
pharmacy school and must be supported
throughout the pharmacist’s career
3. Communicator
 We have to continue learning – education does
 The pharmacist is in an ideal position between
not stop inside the four corners of the room
physician and patient
 Training, webinars, seminars
 We have to be very good when it comes to
 Regularly update our knowledge and skills
communication because we have to relay what
because of new products and new diseases
is needed when it comes to drug information
 Continuing professional development (CPD)
(do’s and don’ts)
  Hospital
 Industry
7. Teacher
 The pharmacist has a responsibility to assist
with the education and training of future GOVERNMENT
generations of pharmacists → not only in the  For the reason of health technology approval such
academe as in the pharmacy: the drugs that we need to
 Education of pharmacy assistants and market.
colleagues
 Teacher to our colleagues, family, and to the This is because the government wanted to have
general public standardization when it comes to health technology
assessment. It is really important to have standard
8. Entrepreneur guidelines when it comes to policy-making or decision-
 The pharmacist must learn how to make market making because we are mostly concerned of those
health technologies that will be used by the public.
survey in the chosen area, plan, direct, and
manage a new pharmacy business
Having this standardized health technology assessment
 Pharmacy profession is very flexible
would be able to help policy-makers and decision-
 Must be very good when it comes to market makers when it comes to the healthcare industry.
survey Health technology assessment is a bridge between the
 Assess whether location is good enough, if it world of research and the world of decision-making.
can serve a lot of people, and aligned with the
business plan If we may relate health economic evaluation, it is
important to note that whatever type of analysis or
9. Researcher combination of analysis is conducted, economic
 The pharmacist must conduct research that will comparisons are but one part of those decision-making
investigate new molecules and design new processes. Aside from the economic perspective, we
models of practice have to consider social values, legal, ethical, and
political considerations, which are incorporated into the
 Good in chemistry and interested in
decision-making process. We wanted to prevent bias
pharmacology, especially in drug development
decisions when it comes to the government sector.
and in combatting new emerging diseases like
the COVID-19 Examples:
1. FDA to decide whether to permit the commercial
10. Agent for positive change use (marketing) of a drug, device or other
 The pharmacist must be the lead in creating technology
change in pharmacy practice to improve patient  We have to make sure that we are considering
care, pharmacy services, and inter-professional that these health technologies deserve to be in
collaboration. the market. If they are there in the market, they
 We have to act professionally even if patients must be able to provide the best benefit as well.
have many questions, so that they do not self- There has to be standards and guidelines.
medicate or need to go to another drugstore.
2. A government health department official about
 We do not just sell and dispense.
undertaking public health programs (e.g. COVID-19
vaccination programs)
 Since it involves the public, we have to be very
Pharmacoeconomics as Applied to various careful when it comes to the selection of public
Pharmacy Settings health programs that we implement. There are
Application of health technology assessment and a lot of government health programs which
pharmacoeconomics mainly in the pharmaceutical were implemented and very beneficial to all of
industry: us.
 Government
3. Resource Allocation They might ask questions like: Do we really need
 We only have limited resources, especially for it? Will it really benefit the patient?
government. This is why we have allocated This is why it does not only involve pharmacist,
funds. So, we have to always consider that these especially when we talk about healthcare.
healthcare budgets being given to the
government for public usage must have that
value for money. INDUSTRY
 In pharmacoeconomics, we wanted to get the
Examples:
most benefit or the value of the product. Same
1. Healthcare payers, providers, and employers
with the government, they wanted to
about whether technologies should be
implement policies and programs, so that the
included in health benefit plans or disease
taxes that we are paying will be replaced with
management programs.
good values and benefits for the people.
 There are payers and providers, especially
insurance companies. They do not cover
In the Philippines, one of the good things which was
everything and you will just have co-payment.
implemented, especially by FDA, is their effort to
This is the same with other technologies apart
decrease the prices of essential medicines (price
from medicine like whether they would be
regulation). If we do not regulate the prices of the
covering the purchase of BP apparatus,
medicines, it could be abused. The Department of
glucometer, sphygmomanometer.
Health (DOH) has set up a low cost drug program and
 So, this kind of discussions and decisions
we are very aggressive when it comes to the
involves whether they will include or cover a
campaigning of generic prescribing.
certain kind of technology when providing
insurance coverage to patients.
HOSPITAL
2. “Standard-setting” for health technology, and
Since we are in the pharmaceutical field, when it comes healthcare delivery regarding the manufacture,
to this field of practice in the hospital, in coming up with use quality of care, and other aspects of
the hospital formulary, health technology assessment healthcare technologies
and pharmacoeconomics are being applied to.  It is really important for us to know that we
also play important role when it comes to
Examples: educating our patients on the proper usage
1. Formulary / Utilization Management of medical devices or equipment that we
 Most countries have different National are carrying in the pharmacy, for the
Formulary because each country has different patient’s usage.
medicines and brand names, but of course,  As pharmacist, we have to demonstrate on
generic names would remain the same. Aside how to use the device. We have to put our
from that national formulary, we also have what hearts with what we are doing. We have to
we call as hospital formulary wherein only those ask whether one needs help in using the
medicines carried by the hospital are listed. bought equipment.
 When manufacturing these products,
2. Implementation of some healthcare programs such especially drugs, it's crucial to ensure the
as Breast-feeding support programs use of high-quality ingredients and
 There are actually some hospitals which do not procedures to guarantee a top-notch
allow you to bring formula milk, especially if product rating of 5 out of 5. We only want
someone gave birth to public hospitals. to serve the best to our patients and
consumers.
3. A hospital must decide whether or not to purchase
a magnetic resonance imaging (MRI) unit
 For some equipment, whether they will be
purchased by the hospital and/or use it in the
diagnosis of a patient’s disease or not, they will
be discussing because it involves money (funds).