ARCS Conferences

Strategies for literature searching and optimising outputs and Health Technology Assessment in Australia – Who Said What, When: A Literature Review (TM4)

Part 1: Searching for the Evidence and Optimising the Relevance of Retrieval

Synopsis:

Clinical evidence research needs to uncover as much relevant literature as possible to be reliable.   Medical databases such as Embase and MEDLINE, are highly structured with complex indexing rules;  but a key advantage of these databases is that they can be searched electronically both for words in the title or abstract (free text) and by using the standardised indexing terms (controlled vocabulary of subject headings), assigned to each record.   However, a certain level of skill and experience is necessary to achieve good (sensitive and precise) results.   To systematically retrieve a maximum number of references and extract the evidence, it is necessary to plan the search strategy in advance.   Formulating a focussed search question, aids the search strategy design and optimises the process used to identify relevant results.

The review question provides the framework for the search elements and the inter-relationship between these concepts.   PICO is a four-part model used to identify the main concepts being examined – PICO is an acronym for patient (or participant or population or problem), intervention, comparison and outcome.   PICO plus study design become the architectural elements for the electronic search.   The Peer Review of Electronic Search Strategies Guideline for literature searching with its evidence based checklist component provides the basis upon which a search strategy may be assessed.   This presentation plans to highlight these initiatives and other factors to consider when translating a review question, developing a search brief or designing search strategies.

Target audience:

All, but especially anyone likely to be responsible for preparing a brief from which searches are conducted.

Learning objectives :

• To learn how to prepare an optimal literature search brief for a librarian or search intermediary
• To understand the adaptation of a research question into a search strategy design and process
• To increase awareness of the processes involved when conducting a systematic electronic literature search for PBAC Submissions
• To develop an appreciation for the skill of literature searching and mechanisms used to optimise the records retrieved
• To gain insight into the structure of medical databases and the interfaces or platforms used to access them

Part 2: Health Technology Assessment in Australia – Who Said What, When: A Literature Review

As the role of health technology assessment (HTA) agencies becomes more influential, decisions to list drugs on national formularies are increasingly subjected to scrutiny across many jurisdictions.  Various players within the pharmaceutical market have sought to deepen their understanding of the role of HTA agencies, amidst tightening budgetary controls imposed by payers in response to escalating costs.  Parallel to this observation is the increasing number of research publications that examined the role of HTA agencies.

With this in mind, a literature review was conducted focusing on the Pharmaceutical Benefits Advisory Committee (PBAC).  Some articles can be traced to the early 1990s, a period which coincided with the compulsory inclusion of an economic assessment in new drug applications seeking public subsidy.  Drummond¹ and Henry² separately highlighted Australia as the first country that was using economic evaluation to inform policy decisions on the rational diffusion of health technology.  Both authors commented on the PBAC Guidelines of which key aspects remain until today, such as the choice of the comparator drug, the evaluation perspective, the range of costs and the valuation of outcomes. 

The growing influence of the PBAC has been matched by the increasing number of publications found in the literature.  These included studies which examined the timeliness of patient access³, factors that influence PBAC outcomes⁴ and the industry methodology in estimating health-related QoL⁵.  Others compared the PBAC with different HTA agencies in their decision-making^6,7 and their broader policy implications on social fairness⁸ and political acceptability⁹.       

Given the diversity of articles with wide ranging subject matter, the aim of the presentation is to provide a framework to look at these publications broadly in order to uncover some general themes and trends that may contribute to a better understanding of what the literature says about the HTA environment in this country.

1. Drummond MF. Basing prescription drug payments on economic analysis: the case of Australia. Health Affairs 1992; 11(4):191-196
2. Henry D. Economic analysis as an aid to subsidisation decisions: the development of Australian guidelines for pharmaceuticals. Pharmacoeconomics 1992;1:54-67
3. Wonder M et al. Are Australians able to access new medicines on the Pharmaceutical Benefits Scheme in a more or less timely manner? An analysis of Pharmaceutical Benefits Advisory Committee Recommendations, 1992-2003. Value In Health 2006;9(4):205-212
4. Harris A et al. The role of value for money in public insurance coverage decisions for drugs in Australia: a retrospective analysis 1994-2004. Medical Decision Making 2008;28:713-722
5. Scuffham P et al. The use of QALY weights for QALY calculations. Pharmacoeconomics 2008;26(4):297-310
6. Clement F et al. Using effectiveness and cost-effectiveness to make drug coverage decisions. A comparison of Britain, Australia and Canada. JAMA 2009;302(13):1437-1443
7. Lexchin J et al. Medicine reimbursement recommendations in Canada, Australia and Scotland. American Journal of Managed Care 2008;14(9):581-588
8. Mitton CR et al. Centralized drug review processes: are they fair? Social Science & Medicine 2006;63:200-211
9. Morgan SG et al. Centralized drug review process in Australia, Canada, New Zealand and the United Kingdom. Health Affairs 2006;25(2):337-347.

• Next: PLAC Stream – Industry reflections on working with the Prostheses List Advisory Committee (PLAC) and its Clinical Advisory Groups (CAG) (TD5)
• Previous: MSAC Stream (TD3)