The Brief Economic Commentary (BEC) was designed to summarise the existing economic evidence. As it is strictly only a summary of key aspects of the existing evidence, it is the approach which requires both the least amount of experience with economics and the least amount of researcher time of the three approaches set out above. The method was designed to be able to be carried out without requiring specialist input from health economists, beyond initial guidance and training in the method and procedures [5].
When including a BEC in a Cochrane review, the first stage is to include relevant economic information into the background section. This can include referring to previous studies which assess the cost of illness of the condition, cost of the intervention and relevant issues around cost effectiveness (e.g., changes in the clinical area that could impact resource use). An additional economic search is also conducted, with this reported in the search strategy part of the methods section. To identify the intervention, the same search terms used in the main effects search are used. However, terms related to study design (e.g., a randomised trial) are replaced by those used to identify economic evaluation studies. An example of an economic search strategy is shown in Fig. 1, which is taken from the Cochrane Economics Methods chapter [5].
There are two factors to consider when deciding about the inclusion of an economic studies into a BEC. The first is the suitability of the interventions being evaluated. The inclusion criteria for the interventions should be the same as those for effectiveness review, this includes the population, intervention, comparison and outcomes (PICO). The second consideration is the type of economic evaluation studies which should be included. The inclusion criteria for economic evaluations can include evaluations conducted alongside clinical studies (trial-based evaluations) and those which used existing literature to create an economic model (model-based evaluations). Other factors which can be considered are the kind of outcome measures utilised such as clinical outcomes, quality adjusted life years (QALYs) or monetary measures of benefit. If both interventions being analysed and the economic methods meet the inclusion criteria, then the study should be included in the BEC.
For a BEC, the studies can be screened for inclusion by a single reviewer. Once suitable economic evaluations have been identified, the conclusions are reported as the author reports them. As such, the author’s own words should be used wherever possible. The key factors that should be reported in the BEC are; the analytic framework, the perspective of the evaluation, the main items that were costed and the setting of the evaluation (country, currency, year) [5]. The resulting paragraph should summarise the author’s conclusion and any uncertainty around those conclusions. As the quality of the included studies is not assessed and the author’s conclusions are presented at face value, it is important to state this explicitly either at the beginning or the end of the commentary, so that those who are reading are aware that the evidence being presented has not had an independent quality assessment.
BEC Case Study - Taken from Lawrie et al (2019)
To understand the long term side effects (neurocognitive or otherwise) of radiotherapy for those with glioma (with or without chemotherapy) a systematic review of studies comparing the side effects of different treatments was carried out as part of the previously described programme grant [8]. The review included randomised and non-randomised trials and controlled before and after studies (CBAS). The review concluded that there may be in increased risk of neurocognitive side effects in those who undergo radiography with a good prognosis, but the evidence is uncertain due to paucity of data and risk of bias.
To complement the clinical component of the review, a BEC was included. The results of the BEC found no relevant economic evaluations with regard to side effects of radiotherapy for those with glioma. This further highlighted a paucity of evidence of long-term side effects of radiotherapy in those with glioma. The review concludes that in addition to the necessity for high quality clinical studies there is also a need for economic evaluation studies to understand the resources implication of any potential side effects from radiotherapy.
Although no economic evaluations were identified in this particular BEC, it was made clear that not we did not attempt to draw any firm or general conclusions regarding the relative costs or efficiency of studies due to the lack of quality appraisal of the economic evaluations. The BEC in this context provides a snapshot of the current economic literature without drawing firm conclusions regarding the cost effectiveness of the strategies.