Economic evaluations and cost analyses in posttraumatic stress disorder: a systematic review

Figures & data

Figure 1. Study selection process.

Table 1. Characteristics of cost-of-illness studies, cost-effectiveness analyses and cost-utility analyses.

Study	Study year	Country	Study design	Study sample	Age in mean years (SD)	PTSD measure/utility measure	Sample size
COIs – Excess costs
Chan et al. (2003)	2003	Australia	OS	Victims of traffic accidents	39 (13) and 39 (13)^a	PCL-C	391
O’Donnell et al. (2005)	2005	Australia	OS	Victims of traffic accidents	37 (14)	CAPS	255
Chan et al. (2009)	2009	USA	OS	Veterans with depression	-	PC-PTSD	606
Eekhout et al. (2016)	2016	The Netherlands	OS	Soldiers deployed to Afghanistan	28 (9)	SRIP	1,007
Lamoureux-Lamarche et al. (2016)	2016	Canada	OS	Older adults aged >65	72 (6) and 74 (6)^a	PTSS	1,456
COIs – Cost comparisons based on (sub-)groups
Walker et al. (2003)	2003	USA	OS	Females aged 18 to 65	42 (12)	PCL-C	1,225
Suris et al. (2004)	2004	USA	OS	Female sexually assaulted veterans	47 (12)	CAPS	270
Priebe et al. (2009)	2009	Persons from FYR living in Croatia, Serbia, Germany, UK	ES	War-affected adults aged 18 to 70	43 (12)	CAPS	264
Priebe et al. (2010)	2010	FYR	OS	War-affected adults aged 18 to 65	44 (11)	CAPS	463
Ivanova et al. (2011)	2011	USA	OS	Adults aged 18–64 who had at least 2 claims for PTSD based on ICD-9	38 (12) and 43 (12)^b	-	18,834
Sabes-Figuera et al. (2012)	2012	BiH, Croatia, Kosovo, FYR Macedonia, Serbia, and persons from FYR living in Germany, Italy, UK	OS	War-affected adults aged 18 to 65	42	LSC-R; MINI	4,167
Ferry et al. (2015)	2015	Northern Ireland	OS	Adults who met the criteria for 12-month or lifetime DSM-IV PTSD	-	-	4,340
Priebe et al. (2017)	2017	Germany	RCT	Sexually assaulted females with PTSD and comorbid mental disorder	36 (10)	PTDS, CAPS	74
CEAs/CUAs – Psychotherapy
Gospodarevskaya & Segal (2012)	2012	AU	M-CUA	Sexually abused children with PTSD	-	QALY	-
Morland et al. (2013)	2013	USA	QES-CEA	Male veterans with PTSD and moderate to severe anger problems	56 (8)	CAPS	74
Le, Doctor, Zoellner, & Feeny (2014)	2014	USA	RPT-CUA	Adults aged 18 to 65 with PTSD based on DSM-IV	38 (11)	QALY (EQ-5D-3 L)	200
Mihalopoulos et al. (2015)	2015	AU	M-CUA	Adults, children and adolescents with PTSD based on DSM-IV	-	QALY (AQoL-4D)/DALY	-
Macdonald et al. (2016)	2016	UK	M-CEA	Sexually abused children	-	-	-
Slade et al. (2017)	2017	USA	RCT-CEA	Adults with severe PTSD and severe mental disorder	44 (1) and 43 (1)^c	CAPS	183
Shearer et al. (2018)	2018	UK	RCT-CUA + M-CUA	Children and adolescents aged 8 to 17 with PTSD based on ICD-10	-	QALY (CHU-9D)	29
Aas, Iversen, Holt, Ormhaug, & Jensen (2019)	2019	Norway	RCT-CUA	Adolescents aged 10 to 18 with PTSD symptoms based on CPSS	15 (2)	QALY (16D)	156
CEAs/CUAs – Integrated care
Domino, Morrissey, Nadlicki-Patterson, & Chung (2005)	2005	USA	QES-CEA	Physically and/or sexually abused females with mental health and substance use disorder	-	-	2,006
Cohen et al. (2017)	2017	USA	M-CEA	Adults with PTSD after natural disaster	-	DALY/PCL	2,642,713
Painter, Fortney, Austen, & Pyne (2017)	2017	USA	RCT-CUA	Veterans with PTSD based on CAPS	52 (14)	QALY (QWB)	265
Chang, Andersen, Berisha, Estrup, & Wang (2018)	2018	Kosovo	RCT-CUA	War-affected persons with comorbid disorders	-	QALY (WHODAS 2.0)	34
CEAs/CUAs – Other
Issakidis, Sanderson, Corry, Andrews, & Lapsley (2004)	2004	AU	M-CEA	Adults who had a claim for PTSD based on ICD-10	-	YLD	129,211
Partial EE
Fontana & Rosenheck (1997)	1997	USA	QES	Male veterans with PTSD	45 (3)	CAPS, M-PTSD	785
McCrone et al., (2005)	2005	UK	RCT	Sexually abused female children	-	O-PTSD	71
Gilbert (2009)	2009	USA	QES	Females with co-occurring disorders and histories of abuse victimization	37	PTDS	2,001
Wood et al. (2009)	2009	USA	QES	Males with combat-related PTSD based on DSM-IV	-	PCL-M	12
Greer, Grasso, Cohen, & Webb, (2014)	2014	USA	OS	Maltreated children with PTSD symptoms	12	UCLA PTSD	180

AU: Australia, BiH: Bosnia and Herzegovina, AQoL-4D: assessment of quality of life instrument, CEA: cost-effectiveness analysis, CHU-9D: child health utility index 9D, COI: cost-of-illness study, CPSS: child posttraumatic symptom scale, CUA: cost-utility analysis, CAPS: clinician-administered PTSD scale, DALY: disability-adjusted life years, DSM: diagnostic and statistical manual of mental disorders, EE. economic evaluation, ES: exploratory study, FYR: Former Yugoslav Republic, HTQ: Harvard trauma questionnaire, ICD: international statistical classification of diseases and related health problems, LSC-R: life stressor checklist-revised, MINI: mini international neuropsychiatric interview, M: model-based study, M-PTSD: Mississippi scale for combat-related PTSD, O-PTSD: Orvaschel’s scales for PTSD, OS: observational study, PC-PTSD: primary care PTSD screen, PCL: PTSD checklist, PCL-C: PTSD checklist–civilian version, PCL-M: PTSD checklist–military version, PTDS: posttraumatic diagnostic scale, PTSD: posttraumatic stress disorder, PTSS: posttraumatic stress syndrome scale, QALY: quality-adjusted life years, QES: quasi-experimental study, QWB: quality of well-being scale, RCT: randomized controlled trial, RPT: randomized preference trial, SD: standard deviation, SRIP: Self Report Inventory for Posttraumatic stress disorder, UCLA PTSD: University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index for DSM-IV, UK: UK, USA: USA, WHODAS 2.0: 12-item short-form version of the World Health Organisation disability assessment schedule 2.0, YLD: years lived with disability.

^aPersons with PTSD and persons without PTSD, ^b Medicaid patients and privately insured patients, ^c Patients in cognitive-behavioural therapy group and patient group with a brief intervention that focused on breathing retraining and psychoeducation.

Table 2. Cost-of-illness per person per year in 2015 US-$ PPP.

		Direct costs
Study	Study group	Total	Psychiatric contact*	Inpatient treatment**	Outpatient physician**	Drugs	Non-physician outpatient contact	Rehabilitation	Non-medical contact	Other costs	Indirect costs
Excess costs
Chan et al. (2003)	PTSD compared to no PTSD	4,295	1,266	251	1,833	69	707	-	3,334	-	5,021^a
O’Donnell et al. (2005)	PTSD compared to no PTSD/high physical functioning	19,435	1,460	7,342	4,250	-	6,384	-	-	-	-
	PTSD compared to no PTSD/low physical functioning	3,203	1,142	−1,084	608	-	2,537	-	-	-	-
Chan et al. (2009)	PTSD compared to no PTSD	2,579	1,648	−3,933	1,670^b	565	-	-	-	507 ^c	-
Eekhout et al. (2016)	High SRIP scores compared to lower SRIP scores***	521	-	-	-	-	-	-	-	-	-
Lamoureux-Lamarche et al. (2016)	PTSS positive compared to PTSS negative	1,414	-	−44	413	849	-	-	-	-	-
Other cost comparisons
Walker et al. (2003)	Low PCL score	2,316	49	414	1,903	225	-	-	-	-	-
	Moderate PCL score	2,504	211	266	2,238	338	-	-	-	-	-
	High PCL score	4,306	228	643	3,663	466	-	-	-	-	-
Suris et al. (2004)	Non-military sexual assault	23,207	6,141	-	-	-	-	-	-	-	-
	Military sexual assault	19,392	4,235	-	-	-	-	-	-	-	-
	Non-sexual assault	13,200	2,115	-	-	-	-	-	-	-	-
Priebe et al. (2009)	Croatia	9,274	-	105	526	130	6	-	-	-	8,520^d
	Serbia	7,110	-	1,342	359	198	6	-	-	-	5,212^d
	Germany	14,802	-	2,795	2,850	563	43	-	-	19^e	8,532^d
	UK	7,648	-	365	686	346	383	-	-	56^e	5,806^d
Priebe et al. (2010)	Belgrade	590	504	-	139	-	-	6	68	-	-
	Sarajevo	198	128	523	2	-	3	12	2	-	-
	Rijeka	575	289	111	170	-	2	-	2	-	-
	Zagreb	485	345	51	37	-	2	62	11	-	-
Ivanova et al. (2011)	Medicaid	20,762	2,985	8,263	11,954	6,166	-	-	-	423 ^f	-
	Medicaid/MDD	19,918	1,558	7,369	11,944	5,917	-	-	-	324 ^f	-
	Private insurance	12,134	1,246	3,971	6,445	2,682	-	-	-	545 ^f	-
	Private insurance/MDD	11,098	853	3,408	5,587	2,815	-	-	-	416 ^f	-
Sabes-Figuera et al. (2012)	UK	2,337	199	-	-	383	-	-	-	776 ^g/979^e	-
	Germany	9,591	2,923	-	-	239	-	-	-	1,123 ^g/5,305^e	-
	Italy	2,486	81	-	-	59	-	-	-	632 ^g/1,714^e	-
	Serbia	835	32	-	-	9	-	-	-	176 ^g/614^e	-
	Croatia	1,096	320	-	-	50	-	-	-	257 ^g/474^e	-
	BiH	875	230	-	-	54	-	-	-	158 ^g/429^e
	FYR Macedonia	429	18	-	-	18	-	-	-	99 ^g/289^e
	Kosovo	289	41	-	-	9.02	-	-	-	63 ^g/171^e
Ferry et al. (2015)	Ireland	26,991	4,328	6,715	5,037	4,631	5,666	-	-	-	3,032 ^h
Priebe et al. (2017)	Before treatment	24,594^i	24,594	20,643^i	2,242^i	2,643^i	-	-	-	-	-
	After treatment	9,828^i	9,828	4,694^i	2,408^i	2,725^i	-	-	-	-	-

BiH: Bosnia and Herzegovina, FYR: Former Yugoslav Republic, MDD: major depressive disorder, PCL: PTSD checklist, PPP: purchasing power parities, PTSD: posttraumatic stress disorder, PTSS: posttraumatic stress syndrome, SRIP: Self Report Inventory for PTSD, UK: UK.

* A psychiatric contact is defined as any psychiatric and psychological treatment in an inpatient and outpatient setting, ** without psychiatric contacts if reported separately, *** split at the 95^th percentile, ^a absenteeism costs, ^b contains non-physician outpatient contact costs, ^c general medical care costs, ^d informal care costs, ^e costs declared as ‘others’, ^f emergency room costs, ^g community healthcare costs, ^h presentism and absenteeism costs, ⁱ total costs not differentiated from psychiatric costs.

Table 3. Cost-effectiveness analyses and cost-utility analyses – included cost categories, incremental effects, and incremental effects and costs and cost-effectiveness in 2015 US-$ PPP per annum.

Study	Treatment	Time horizon (years)	Discount rate of costs/effects (%)	Included cost categories								Incremental costs (US-$ PPP)	Incremental effects	ICER (US-$ PPP per health effect)
				Psychiatric contact^a	Inpatient treatment	Outpatient treatment	Drugs	Non-physician outpatient contact	Rehabilitation	Non-medical contact	Indirect costs
CEAs/CUAs – Psychotherapy
Gospodarevskaya & Segal (2012)	Non-directive counselling vs. no treatment	1	-	+	-	+	+	-	-	+	-	1,480	0.06 QALYs gained	24,667
		31	5.0/-									1,515	1.02 QALYs gained	1,485
	TF-CBT vs. no treatment	1	-									1,464	0.09 QALYs gained	16,263
		31	5.0/-									1,507	1.28 QALYs gained	1,177
	TF-CBT + SSRI vs. no treatment	1	-									1,617	0.10 QALYs gained	16,170
		31	5.0/-									1,632	1.34 QALYs gained	1,218
	TF-CBT vs. non-directive counselling	1	-									−16	0.03 QALYs gained	Dominant
		31	5.0/-									−20	0.20 QALYs gained	Dominant
	TF-CBT + SSRI vs. non-directive counselling	1	-									−137	0.04 QALYs gained	Dominant
		31	5.0/-									−105	0.26 QALYs gained	Dominant
	TF-CBT + SSRI vs. TF-CBT	1	-									125	0.01 QALYs gained	12,502
		31	5.0/-									124	0.06 QALYs gained	2,071
Morland et al. (2013)	CVT anger management vs. in-person anger management	Varying	-	+	-	-	-	-	-	-	-	−745	5%/15%/18% reduction on NAS-T/T-ANG/AEI score	Dominant^b
Le et al. (2014)	Prolonged exposure therapy vs. sertraline	1	-	+	+	+	+	-	-	+	+	−274	0.06 QALYs gained	Dominant
	Choice of treatment vs. no choice of treatment											−1,907	0.01 QALYs gained	Dominant
Mihalopoulos et al. (2015)	TF-CBT vs. TAU (adults)	5	3.0/3.0	+	-	+	+	+	-	-	-	57,914	4.40 QALYs gained	13,162
	TF-CBT vs. TAU (children and adolescents)											622	0.09 QALYs gained	6,912
	SSRI vs. TAU (adults who are prescribed medication)											858	3.70 QALYs gained	232
Macdonald et al. (2016)	TF-CBT vs. TAU	1	-	+	-	-	-	-	-	-	-	2015	0.30 point reduction of SMD psychological distress/mental health	6,502
Slade et al. (2017)	TF-CBT vs. breathing retraining and psychoeducation	1	-	+	+	+	+	+	-	+	-	4,330	11% additional PTSD remission	39,366
Shearer et al. (2018)	TF-CBT vs. TAU	3	3.5/3.5	+	+	+	+	+	-	+	-	139	0.04 QALYs gained	3,159
Aas et al. (2019)	TF-CBT vs. TAU	2	-	+	-	-	+	-	+	+	-	−150	0.04 QALYs gained	Dominant
CEAs/CUAs – Integrated care
Domino et al. (2005)	CIT and CSR-involved services vs. TAU	0,5	-	+	+	+	+	-	-	+	-	−19	38% reduction on PSS score	Dominant
Cohen et al. (2017)	Stepped care + non-TF-CBT vs. TAU	10	3.0/3.0	+	-	-	-	-	-	-	-	16	0.00 DALYs averted	3,319
													20.04 additional PTSD-free days	1
Painter et al. (2017)	Telemedicine-based collaborative care vs. enhanced TAU	1	-	+	-	+	+	-	-	-	-	2,605	0.01 QALYs gained	193,781
Chang et al. Chang et al. (2018)	Multidisciplinary rehabilitation programme^c vs. waiting list + multidisciplinary rehabilitation programme	1.5	3.5/3.5	-	-	-	-	-	+	-	+	1,301^d	0.10 QALYs gained^e	13,421
CEAs/CUAs – Other treatment
Issakidis et al. (2004)	Optimal treatment^f vs. TAU	1	-	+	+	+	+	-	-	+	-	−80	0.02 YLD averted	Dominant
Partial EEs
Fontana & Rosenheck (1997)	Treatment in long-stay PTSD units vs. treatment in short-stay PTSD units	1	-	+	+	+	-	-	-	-	-	29,949	3.6/−3.2 point reduction on CAPS score/M-PTSD score	-
	Treatment in long-stay PTSD units vs. treatment in general psychiatric units											23,100	7.5/−1.8 point reduction on CAPS score/M-PTSD score	-
	Treatment in general psychiatric units vs. treatment in short-stay PTSD units											6,849	−3.9/−1.4 point reduction on CAPS score/M-PTSD score	-
McCrone et al. (2005)	Individual psychotherapy vs. group psychotherapy	Varying	-	+	-	-	-	-	-	-	-	2,207	Similar effective	-
Gilbert, (2009)	Integrated counselling vs. TAU	1	-	+	+	+	+	+	+	+	+	−9,405 ^g	Greater improvement in PTSD symptoms	-
Wood et al. (2009)	Virtual reality graded exposure therapy vs. TAU	10 weeks	-	+	-	-	-	-	-	-	-	−125,730	More effective	-
Greer et al. (2014)	TF-CBT vs. TAU	1	-	+	+	+	-	+	-	-	-	−104,737	Greater reduction in post-traumatic stress	-

AEI: Anger Expression Index subscale of State-Trait Anger Expression Inventory-2, CBT: cognitive-behavioural therapy, CIT: comprehensive, integrated, trauma informed, CSR: consumer/survivor/recovering person, CVT: clinical video teleconferencing, DALY: disability-adjusted life year, EE: economic evaluation, NAS-T: Novaco Anger Scale Total, PPP: purchasing power parities, PSS: post-traumatic stress symptom scale, CAPS: clinician-administered PTSD scale, HTQ: Harvard trauma questionnaire, ICER: incremental cost-effectiveness ratio, QALY: quality-adjusted life year, SMD: standard mean difference, SSRI: selective serotonin reuptake inhibitor, T-ANG: Trait Anger subscale of State-Trait Anger Expression Inventory-2, TAU: treatment as usual; TF-CBT: trauma focused-cognitive-behavioural therapy, YLD: years lived with disability.

^aPsychiatric contact is defined as any psychiatric and psychological treatment in an inpatient and outpatient setting, ^b the cost-effectiveness analysis was based on a non-inferiority randomized controlled trial, ^c the multidisciplinary rehabilitation programme consisted of physiotherapy, biofeedback-supported psychotherapy and social support, ^d the incremental costs were reported as mean costs of the intervention group and control group, ^e the incremental effect was reported as mean QALY of the intervention group and control group, ^f optimal treatment was not further specified by the authors, ^g females with moderate to severe PTSD.

Table 4. Quality assessment of cost-of-illness-studies according to the adapted COI quality checklist by Schirr-Bonnans et al. (2017).

Item of quality assessment	Excess costs					Cost comparisons based on (sub-)groups								Studies that fulfilled criterion (%)
	Chan et al. (2003)	O’Donnell et al. (2005)	Chan et al. (2009)	Eekhout et al. (2016)	Lamoureux-Lamarche et al. (2016)	Walker et al. (2003)	Suris et al. (2004)	Priebe et al. (2009)	Priebe et al. (2010)	Ivanova et al. (2011)	Sabes-Figuera et al. (2012)	Ferry et al. (2015)	Priebe et al. (2017)
Was a clear definition of the illness given?	(✓)	✓	(✓)	−	✓	✓	✓	✓	✓	(✓)	−	(✓)	✓	54
Was the epidemiological approach described?	(✓)	✓	✓	✓	✓	✓	✓	(✓)	✓	(✓)	(✓)	(✓)	✓	62
Was the perspective described?	−	−	−	−	✓	✓	−	−	−	✓	−	−	−	23
Were the different types of costs described?	✓	✓	✓	−	✓	✓	−	✓	(✓)	✓	(✓)	✓	✓	69
Were activity data sources described?	✓	−	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	92
Was cost valuation appropriately described?	−	−	(✓)	(✓)	✓	(✓)	(✓)	✓	−	(✓)	✓	✓	✓	38
Was cost discounting provided?	−	−	N/A	−	N/A	N/A	−	N/A	N/A	N/A	N/A	N/A	N/A	0
Were the major assumptions tested in a sensitivity analysis?	−	−	−	(✓)	−	−	−	(✓)	−	−	(✓)	−	−	0
Was the presentation of study results consistent with the objective and the methodology of the study? Were costs sufficiently disaggregated?	✓	✓	✓	(✓)	✓	✓	✓	✓	(✓)	✓	✓	✓	✓	85
Items fulfilled (%)	33	44	50	22	88	75	44	63	38	50	38	50	75	51

[✓] Item was fulfilled without any limitation, [(✓)] item was partially fulfilled, [−] item was not fulfilled, [N/A] not applicable.

COI: cost-of-illness study

Table 5. Quality assessment of trial-based economic evaluations according to the CHEC-list (Evers et al., 2005).

Item of quality assessment	Psychotherapy					Integrated Care			Partial EEs					Studies that fulfilled criterion (%)
	Morland et al. (2013)	Le et al. (2014)	Slade et al. (2017)	Shearer et al. (2018)	Aas et al. (2019)	Domino et al. (2005)	Painter et al. (2017)	Chang et al. (2018)	Fontana & Rosenheck (1997)	McCrone et al. (2005)	Gilbert (2009)	Wood et al. (2009)	Greer et al. (2014)
Clearly described study population	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	100
Clearly described competing alternatives	−	✓	✓	✓	✓	−	✓	✓	✓	✓	✓	✓	✓	85
Well-defined research question	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	100
Appropriate economic study design	✓	✓	✓	✓	✓	✓	✓	✓	−	−	−	−	−	62
Appropriate time horizon	−	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	−	✓	85
Appropriate perspective	−	✓	−	−	✓	−	−	✓	−	−	✓	−	−	31
Important and relevant costs identified	−	✓	✓	✓	−	✓	✓	−	−	−	✓	−	−	46
Costs measured appropriately	−	✓	✓	✓	✓	✓	−	−	✓	✓	✓	−	✓	69
Costs valued appropriately	✓	✓	✓	−	✓	✓	−	−	✓	✓	✓	−	−	62
Important and relevant outcomes identified	✓	✓	✓	−	✓	✓	✓	✓	✓	✓	✓	✓	−	85
Outcomes measured appropriately	✓	✓	✓	✓	✓	✓	✓	−	✓	✓	✓	✓	−	85
Outcomes valued appropriately	−	✓	✓	−	✓	−	✓	−	−	−	−	−	−	31
Incremental analysis performed	✓	✓	✓	✓	✓	✓	✓	−	−	−	−	−	−	54
Costs and outcomes discounted appropriately	−	✓	✓	✓	−	✓	✓	✓	✓	−	✓	−	✓	69
Appropriate sensitivity analysis	−	✓	✓	✓	✓	✓	−	−	−	−	−	−	−	31
Conclusion follow the data reported	✓	✓	✓	✓	✓	✓	✓	−	✓	✓	✓	−	−	77
Study discusses the generalizability	−	✓	✓	✓	−	✓	✓	✓	−	−	−	✓	−	54
Article indicates no potential conflict of interest	✓	✓	✓	✓	−	✓	✓	−	−	✓	−	✓	✓	69
Ethical and distributional issues discussed appropriately	−	−	−	−	−	−	−	−	−	−	−	−	−	0
Items fulfilled (%)	47	95	89	74	74	79	74	47	53	53	63	37	37	62

[✓] Item was fulfilled without any limitation, [−] item was not fulfilled.

CHEC: Consensus on Health Economic Criteria, EE: economic evaluation.

Table 6. Quality assessment of model-based economic evaluations according to the ISPOR questionnaire (Jaime Caro et al., 2014).

Item of quality assessment	Psychotherapy				Integrated Care	Other	Studies that fulfilled criterion (%)
	Gospodarevskaya & Segal (2012)	Mihalopoulos et al. (2015)	Macdonald et al. (2016)	Shearer et al. (2018)	Cohen et al. (2017)	Issakidis et al. (2004)
Population relevant	✓	✓	✓	✓	✓	✓	100
Critical interventions missing	✓	✓	✓	✓	✓	−	83
Relevant outcomes missing	✓	✓	−	✓	✓	✓	83
Context applicable	✓	✓	−	✓	−	−	50
External validation of the model sufficient	✓	✓	−	−	✓	−	50
Internal validation of the model sufficient	−	−	−	−	−	−	0
Face validity sufficient	✓	✓	−	−	✓	−	50
Design of the model adequate	✓	−	−	−	✓	−	33
Data used in populating the model suitable	−	✓	✓	−	−	✓	50
Analysis performed using the model adequate	✓	✓	−	✓	✓	✓	83
Effects of uncertainty adequately assessed	✓	✓	✓	✓	✓	✓	100
Reporting of the model adequate	✓	✓	✓	✓	✓	✓	100
Interpretation of results fair and balanced	−	✓	−	✓	−	−	33
Potential conflict of interest	✓	✓	✓	✓	✓	✓	100
Conflicts of interest addressed	✓	✓	−	✓	✓	−	67
Items fulfilled (%)	80	87	40	67	73	47	64

[✓] Item was fulfilled, [−] item was not fulfilled, [?] can’t answer item fulfilment.

ISPOR: International Society for Pharmacoeconomics and Outcomes Research.

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