Reply to Roberts et al.: CHEERS is Sufficient for Reporting Cost-Benefit Analysis, but May Require Further Elaboration

Roberts and colleagues make the point that our Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist may be insufficient for reporting costbenefit analysis (CBA) in biomedical journals. In particular, they believe CHEERS may need an extension to supplement potentially missing reporting items required for CBA [1]. We were pleased to hear CHEERS was suitable for reporting a cost-utility analysis (CUA) of the same intervention and that the concerns raised are practical, rather than theoretical, and came from using the checklist. CHEERS is still a relatively new instrument that has enjoyed steady uptake, having been cited over five times a month since its publication in 2013 and endorsed in 12 journals (that we are aware of). We would encourage all authors, editors and peer reviewers to provide feedback to the CHEERS Task Force to help improve it after reading our explanation and elaboration document [2] and putting the CHEERS checklist to practical use. However, we are not entirely convinced by Roberts and colleagues’ arguments that CHEERS has ‘significant gaps’. While it is true that CHEERS leans strongly toward providing direction to those conducting cost-effectiveness analyses (CEAs) (including CUA), we would argue that the checklist adequately captures the reporting of a CBA. For example, Item 12 asks authors to report methods of valuing preference-based outcomes and assumes that authors of a CBA would be concerned with valuation of benefits based on preferences for the consequences of different interventions and using methods compatible with standard welfare economic theory. Item 19 then asks authors to report their findings separately for costs and benefits (losses and gains). It is not clear from this letter, then, what additional information included in a CBA would not fit into these and other items in CHEERS. We would acknowledge that CHEERS reflects the current emphasis on CEA approaches in the literature. For example, the recommendation for Item 12 describes methods to elicit preferences although those conducting CBAs may use a revealed preference approach. Similarly, Item 10 asks authors to report their choice of health outcomes, implying those outcomes are incorporated in a CBA and valued in monetary terms. We recognize that, in & Don Husereau dhusereau@ihe.ca