AAPM&R Cost-Effectiveness Bibliography
Methodology
The research team used standard literature synthesis
techniques. The objectives were defined as specified above. A computerized
search strategy was developed and reviewed by advisors including the RAAC.
This strategy was the key means of identifying articles for inclusion in the
bibliography. The literature was classified and categorized and then graded
using the US Preventive Services Task Force quality of evidence rating system.
Studies were included in the bibliography if : (1) the
research design was a meta-analysis, randomized clinical trial, prospective
cohort study, case control, or descriptive; (2) the study addressed physical
medicine and rehabilitation; and (3) the study examined cost-effectiveness,
cost-minimization analyses (CMA), cost-utility analyses (CUA), and
cost-benefit analyses (CBA). The common theme is an analysis of both costs and
outcomes. Also included were studies that may not have compared a treatment to
the standard of care but to any alternative treatment.
Other types of studies that addressed only costs were
not included unless they were methodological studies. Cost-effectiveness
studies are aimed at determining the ratio of costs to outcomes of a
particular intervention or treatment and comparing a standard intervention to
an alternative intervention to determine if the alternative is more
cost-effective than the standard.
Limitations
In reviewing the final report the RAAC noted the
following concerns:
-
the strategic decision to
limit analysis to cost-effectiveness resulted in the exclusion of good
studies that address effectiveness but not cost;
-
the number of studies that
address cost-effectiveness in rehabilitation are few;
-
it was difficult to
identify physiatrist involvement in the study; and
-
despite a broad search
strategy including a hand search and efforts to minimize publication bias,
studies may have been missed.
Despite these limitations, Academy members should find
the CEB to be useful to incorporate into their practice. The RAAC encourages
you to review the bibliography and welcomes your comments, suggestions, and
feedback. A special folder in the Member Discussion Forum is dedicated to
discussion of this project and we encourage members to submit comments to
foster an interactive ongoing dialogue about this important topic. Members who
have questions or need additional information about the CEB project can e-mail
the Academy office at info@aapmr.org.
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