The recent update to the CHEERS Statement sets new reporting standards for economic evaluations and includes some key messages. Economic evaluations should report how the effects of interventions impact on inequalities, and how researchers have involved patients and the public.

What is CHEERS?
Best practice in healthcare research recommends that the reporting of a study’s findings should be done in a standardised, rigorous and transparent way. For this purpose, the research community follows reporting guidelines for different study designs, which are available on the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network website.

Among these, the CHEERS statement is the ‘go-to’ guideline for researchers that need to report the results of an economic evaluation. It was first published in 2013 and has been recently updated.

In particular, the CHEERS Checklist identifies 28 items to report when writing up an economic evaluation, subdivided in the different sections of a journal article:
(1) Title
(2) Abstract
(3) Introduction: Background and Objectives;
Methods, including: (4) Health economic analysis plan; (5) Study population; (6) Setting and location; (7) Comparators; (8) Perspective; (9) Time horizon; (10) Discount rate; (11) Selection of outcomes; (12) Measurement of outcomes; (13) Valuation of outcomes; (14) Measurement and valuation of resources and costs; (15) Currency, price date, and conversion; (16) Rationale and description of model; (17) Analytics and assumptions; (18) Characterising heterogeneity; (19) Characterising distributional effects; (20) Characterising uncertainty; (21) Approach to engagement with patients and others affected by the study;
Results, including: (22) Study parameters; (23) Summary of main results; (24) Effect of uncertainty; (25) Effect of engagement with patients and others affected by the study;
Discussion, including: (26) Study findings, limitations, generalisability, and current knowledge;
Other relevant information, including: (27) Source of funding; (28) Conflicts of interest.

What is an economic evaluation?
An economic evaluation compares the cost and consequences of alternative healthcare interventions. These could be two or more drugs, therapies or treatments.
Economic evaluations are needed as healthcare systems like the NHS have limited resources. This means that we need to make the best use of the resources available and allocate them to the interventions which represent value for money.

An update to CHEERS
The update was needed due to changes in the field of health economics since the first CHEERS statement was published in 2013. This update not only reflects developments in the methods underpinning economic evaluations, but it also recommends reporting on the wider impacts of economic evaluations which go beyond the health of patients, such as:
– The effects on existing inequalities, which implies exploring how the costs and benefits of healthcare interventions are distributed across the population.
– The role played by the patients and the public in developing economic evaluations, which should now be reported.

What are the implications of the update?
New economic evaluations should be reported following the updated 28-item CHEERS Checklist. Importantly, new items have been added which should encourage health economists to report on inequality or distributional effects and the involvement of patients and the public.

Despite the lack of guidance on how to report the involvement of patients and the public in economic evaluations, the CHEERS update represents a significant turning point in recognising the role that people using healthcare services can play in health economic research.

More info:
* Read the CHEERS update here.
* Watch and read a discussion of the CHEERS update with the CHEERS Task Force Co-Chairs here.

Reference:
Husereau, D. et al. (2022) Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations. Value in Health, Volume 25, Issue 1, 3 – 9.

Authors of this blogpost:
Dr Valerio Benedetto and Professor Andy Clegg
Methodological Innovation, Development, Adaptation and Support (MIDAS) Group
NIHR Applied Research Collaboration North West Coast (ARC NWC)