Enhancing Health Economic Evidence with the PICO Framework
The population, intervention, comparator and outcomes (PICO) framework is commonly used to develop clinical research questions and studies. However, it can also be applied within Health Economics and Outcomes Research (HEOR) to characterise the decision problem which an evaluation is aiming to answer.
The four quadrants of the PICO framework allow for a clear statement of interventions being considered and identification of the outcomes that are used to assess their relative economic impact:
Population: which patients are eligible for intervention? How does this population vary by characteristic e.g. sex, age, disease severity and ethnicity?
Intervention: where in the healthcare service could the intervention be placed? Could the intervention be placed in more than one care setting? What information does the intervention provide to healthcare professionals or patients?
Comparator: what is the most appropriate comparator? Does the intervention have an analogue?
Outcomes: what impact can the technology have on health service resource utilisation and patient outcomes? Which outcomes are most important for the economic value story i.e. where will the intervention generate the most value? What data is available to support the intervention with these outcomes?
Best Practices
Align with internationally recognised standards.
As recommended by NICE, the information to appropriately populate the framework should be extracted from a systematic literature review of both relevant clinical and economic literature. If a systematic review is not possible a structured approach should still be utilised to identify the literature. Furthermore, it is essential to engage with key stakeholders to inform and validate the framework, particularly when there is a lack of published evidence.
Case Study
How Hardian solves the problem.
At the beginning of every economic modelling project, Hardian works with their clients to refine and validate any existing PICO frameworks before health economic evidence generation. Alternatively, Hardian can work with technology suppliers to synthesise available information and develop new frameworks.
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Before generating any health economic evidence, ensure that your economic value story is supported by an independently validated and evidenced-based PICO framework.