Was an incremental analysis of costs and consequences of alternatives performed?

Was a well-defined question posed in answerable form?
1.1. Did the study examine both costs and effects of the service(s) or programme(s)?
1.2. Did the study involve a comparison of alternatives?
1.3. Was a viewpoint for the analysis stated and was the study placed in any particular decision-making context?
2. Was a comprehensive description of the competing alternatives given (i.e. can you tell who did what to whom, where, and how often)?
2.1. Were there any important alternatives omitted?
2.2. Was (should) a do-nothing alternative be considered?
3. Was the effectiveness of the programme or services established?
3.1. Was this done through a randomised, controlled clinical trial? If so, did the trial protocol reflect what would happen in regular practice?
3.2. Was effectiveness established through an overview of clinical studies?
3.3. Were observational data or assumptions used to establish effectiveness? If so, what are the potential biases in results?
4. Were all the important and relevant costs and consequences for each alternative identified?
4.1. Was the range wide enough for the research question at hand?
4.2. Did it cover all relevant viewpoints? (Possible viewpoints include the community or social viewpoint, and those of patients and third-party payers. Other viewpoints may also be relevant depending upon the particular analysis.)
4.3. Were the capital costs, as well as operating costs, included?
5. Were costs and consequences measured accurately in appropriate physical units (e.g. hours of nursing time, number of physician visits, lost work-days, gained life years)?
5.1. Were any of the identified items omitted from measurement? If so, does PHE5HEF 2016 Health Economics and Finance 4 this mean that they carried no weight in the subsequent analysis? 5.2. Were there any special circumstances (e.g., joint use of resources) that made measurement difficult? Were these circumstances handled appropriately?
6. Were the cost and consequences valued credibly?
6.1. Were the sources of all values clearly identified? (Possible sources include market values, patient or client preferences and views, policy-makers views and health professionals judgements) 6.2. Were market values employed for changes involving resources gained or depleted?
6.3. Where market values were absent (e.g. volunteer labour), or market values did not reflect actual values (such as clinic space donated at a reduced rate), were adjustments made to approximate market values?
6.4. Was the valuation of consequences appropriate for the question posed (i.e. has the appropriate type or types of analysis – cost-effectiveness, cost-benefit, cost-utility – been selected)?
7. Were costs and consequences adjusted for differential timing?
7.1. Were costs and consequences that occur in the future ‘discounted to their present values?
7.2. Was there any justification given for the discount rate used?
8. Was an incremental analysis of costs and consequences of alternatives performed?
8.1. Were the additional (incremental) costs generated by one alternative over another compared to the additional effects, benefits, or utilities generated?
9. Was allowance made for uncertainty in the estimates of costs and consequences?
9.1. If data on costs and consequences were stochastic (randomly determined sequence of observations), were appropriate statistical analyses performed?

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