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Epidemiologia e Serviços de Saúde

versão impressa ISSN 1679-4974versão On-line ISSN 2337-9622

Epidemiol. Serv. Saúde vol.26 no.4 Brasília dez. 2017 


Guidelines for reporting health economic evaluation studies

Everton Nunes da Silva1  , Marcus Tolentino Silva2  , Federico Augustovski3  , Don Husereau4  , Maurício Gomes Pereira5 

1Universidade de Brasília, Faculdade de Ceilândia, Brasília-DF, Brasil

2Universidade de Sorocaba, Programa de Pós-Graduação em Ciências Farmacêuticas, Sorocaba-SP, Brasil

3Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina

4University of Ottawa, Ottawa, Canadá

5Universidade de Brasília, Faculdade de Medicina, Brasília-DF, Brasil


Throughout this economic evaluation series, we have presented several methodological pieces on how to conduct cost-effectiveness studies. We have also discussed approaches on how to estimate costs and outcomes in health,1-3 analytical models to inform the use of technologies,4 how to deal with uncertainty5 and how to estimate budget impact.6 Each one of these approaches requires a description of methods, data collection and results analysis. Thus, reporting economic evaluation represents a challenge, given the extensive amount of relevant information needed to understand the study with the limited space given in scientific journals.

To support article preparation, the scientific community has developed guidelines to report research. There are hundreds of them.7 They typically instruct authors regarding the information considered essential in a research article. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) is among the available guidelines,8 and is described in this article. Here, we present the Portuguese version of the CHEERS checklist, which is intended for reporting health economic evaluation studies. As a preamble, we provide some general information on research reporting.

Standard structure of a scientific article

In most scientific journals, research reports are standardized.9 The format IMRaD - introduction, methods, results and discussion - is typically adopted. This structure allows a better understanding of the report and its content analysis. Each part of the manuscript must provide information so the reader can understand what has been done. In the introduction, the authors present the subject studied, justification for the investigation and the objective of the report. In the methods, the type of research adopted is presented. The authors may also describe the study context, the characteristics of the investigated sample, the procedures for data collection and analysis, and the ethical aspects. In the results, as the name suggests, the main findings of the research are presented, along with statistical analysis, if applicable. Finally, in the discussion, results are interpreted, with authors typically comparing them with the literature, discussing the study's limitations and providing a conclusion. The conclusion represents the view of the author regarding the research objective. When readers have access to well-reported research, they can decide on the reliability and credibility of the conclusion. If they consider the conclusion reliable, it will influence their professional and personal behaviour.

Besides preparing an IMRaD, as described, there are important parts of a research article, including the title, abstract and bibliographic references.

Guidelines for reporting health economic evaluation studies

The final version of the 24 items described in the original CHEERS Statement8 was the result of a four stage approach, described below:

The first stage consisted of a systematic review of checklists and guidelines related to reporting economic evaluations, in which the researchers selected potential items to consider in the CHEERS guidelines.

The second stage was based on the use of a modified Delphi panel, by which specialists across several areas (academia, clinical practice, industry, government, and the editorial community) evaluated the relevance of the items selected in the previous stage.

The third stage comprised a face-to-face consensus meeting with the members of ISPOR Task Force (International Society for Pharmacoeconomics and Outcomes Research). The specialists’ comments on the modified Delphi panel were revised and a preliminary version of the guidelines was drafted.

The fourth stage included a presentation of the preliminary version at the ISPOR 17th Annual International Meeting. The document was revised based on the comments of the event participants. After that, the revised version was circulated to the members of ISPOR Task Force and once again to the participants of the modified Delphi panel, who developed the final version of the checklist.

Brazilian version of CHEERS

In order to produce a Portuguese version of CHEERS, the following procedure was adopted: i) an economist in health (ENS) and with ten years of experience in the area of economic evaluation translated CHEERS to Portuguese, which was then revised by another researcher (MTS), who has similar experience in economic evaluation; ii) from this draft Portuguese version, a third person (TSAP), a professional with experience in translating scientific articles, and who work for the journal Epidemiology and Health Services - RESS, back-translated the text from Portuguese to English; iii) this back-translation was revised by two authors of the original CHEERS manuscript (FA and DH), from which the final version is being published in this article. This procedure aimed to ensure that the Portuguese and English versions had the same meaning. The final checklist is presented in Figure 1.

Figure 1 - CHEERS a checklist: items to include when reporting economic evaluations of health interventions 


Articles on reporting economic evaluations must be written in IMRaD format. The checklist is intended to increase transparency in reports, because information on each of the 24 items should be contained in the article. It is important to highlight that the checklist contains instructions concerning the title, abstract, introduction, methods, results and discussion. And a last reminder: good research reports are more likely to be accepted when submitted for journal publication. The continued use of these guidelines is certainly a step toward improving the quality of reports in economic evaluation studies.


1. Silva EN, Silva MT, Pereira MG. Estudos de avaliação econômica em saúde: definição e aplicabilidade aos sistemas e serviços de saúde. Epidemiol Serv Saude. 2016 jan-mar;25(1):205-7. [ Links ]

2. Silva EN, Silva MT, Pereira MG. Identificação, mensuração e valoração de custos em saúde. Epidemiol Serv Saude. 2016 abr-jun;25(2):437-9. [ Links ]

3. Silva MT, Silva EN, Pereira MG. Desfechos em estudos de avaliação econômica em saúde. Epidemiol Serv Saude. 2016 jul-set;25(3):663-6. [ Links ]

4. Silva EN, Silva MT, Pereira MG. Modelos analíticos em estudos de avaliação econômica. Epidemiol Serv Saude. 2016 out-dez;25(4):855-8. [ Links ]

5. Silva EN, Silva MT, Pereira MG. Incerteza em estudos de avaliação econômica. Epidemiol Serv Saude. 2017 jan-mar;26(1): 211-3. [ Links ]

6. Silva MT, Silva EN, Pereira MG. Análise de impacto orçamentário. Epidemiol Serv Saude. No prelo 2017. [ Links ]

7. The Equator Network. Enhancing the quality and transparency of health research [Internet]. Equator Network: Oxford; 2017 [Cited 2017 May 3]. Available from: Available from: ]

8. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) - explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health. 2013;16:231-50. [ Links ]

9. Pereira MG. Artigos científicos: como redigir, publicar e avaliar. Rio de Janeiro: Editora Guanabara-Koogan; 2011. [ Links ]

Correspondence: Everton Nunes da Silva - Centro Metropolitano, conjunto A, lote 01, Brasília - DF. CEP: 72220-900. E-mail:

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