Risk of bias in trial-based economic evaluations: Identification of sources and bias-reducing strategies

Abstract

Objective: The objectives of this article are first to give an overview of the risks of bias in trial-based economic evaluations and, second, to identify how key sources for bias can be revealed and overcome (i.e. what bias-reducing strategies might be employed) in future trial-based economic evaluations in the field of health psychology.

Design: Narrative review discussing sources of bias in trial-based economic evaluations and bias-reducing strategies.

Results: We identified 11 biases and assigned them to a particular trial phase. A distinction is made between pre-trial biases, biases during the trial and biases that are relevant after the actual trial. All potential forms of bias are discussed in detail and strategies are shown to detect and overcome these biases.

Conclusion: In order to avoid bias in trial-based economic evaluations, one has to be aware of all the possible forms of bias. All stakeholders have to examine trial-based economic evaluations in a rigorous and stringent manner. This article can be helpful in this examination as it gives an overview of the possible biases which researchers should take into account.

Keywords:

• bias
• bias-reducing strategies
• cost and outcomes
• economic evaluation
• systematic error