Issues of consensus and debate for economic evaluation in rheumatology

We report initial attempts at developing standards for the conduct of economic evaluations in rheumatology. We surveyed 25 clinicians and economists with an interest in rheumatology regarding the design and reporting of economic evaluations, with particular reference to 4 clinical scenarios relating to treatment for rheumatoid arthritis, osteoarthritis, and osteoporosis. The results demonstrated widespread agreement on a number of methodological issues such as statement of funding source, perspective, discounting, and allowance for uncertainty. However, there was lack of consensus over clinical variables including sources of data for efficacy estimates, specific clinical outcomes, methods of assessing quality of life, and choice of comparators. Some of the disagreement reflects lack of consensus in current general methodological guidelines. Consensus regarding the disease-specific clinical variables is crucial to standardizing analysis and facilitating comparisons within clinical scenarios.