The Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklist is the reporting standard peer reviewers, health technology assessment (HTA) bodies, and journal editors now expect for any cost-effectiveness analysis, cost-utility analysis, or budget impact study. Most rejections of health economic manuscripts are not about the model. They are about reporting that leaves reviewers unable to judge the model. CHEERS 2022 exists to close that gap.
What CHEERS 2022 is, and what it is not
CHEERS 2022 is a 28 item reporting checklist published by ISPOR, updating the 2013 original. It tells authors what a complete report of an economic evaluation must contain: the question, the comparators, the perspective, the model structure, the inputs, the uncertainty analysis, and the results, each described in enough detail for a reader to reproduce the logic. It is not a methods quality score. A badly designed model can be reported in full CHEERS compliance, and a good model can fail review because its reporting hides the information reviewers need. The checklist governs transparency, and transparency is what peer review actually tests first.
What changed from CHEERS 2013
- Health economic analysis plan. CHEERS 2022 asks whether an analysis plan was developed and where it can be found, mirroring the shift toward pre-specification across research generally.
- Stakeholder and patient engagement. New items ask whether patients, the public, or communities were involved in the study design and how.
- Distributional effects. The update reflects the growth of distributional cost-effectiveness analysis, asking how impacts are distributed across population groups where relevant.
- Characterizing heterogeneity. Reporting how results differ across subgroups is now an explicit expectation rather than an optional strength.
- One checklist for all evaluations. The 2013 split between trial based and model based reporting formats is gone; a single checklist covers both, alongside budget impact and cost analyses.
The checklist in practice, section by section
Title, abstract, and introduction
The title must identify the study as an economic evaluation and name the interventions compared. The abstract needs a structured summary including the study context, methods, results with the incremental cost-effectiveness ratio (ICER), and conclusions. The introduction states the study question and its policy or practice relevance. Reviewers frequently reject papers whose abstract omits the base case ICER or fails to name the comparator; do not make them hunt.
Methods: the section where reviews are won or lost
- Population and comparators. Define the population with its clinical characteristics and justify the comparators; a cost-effectiveness result against an irrelevant comparator answers no useful question.
- Perspective and setting. State whose costs count (health system, payer, societal) and where the analysis applies, because an analysis built for one country's costs and pathways rarely transfers unmodified.
- Time horizon and discount rate. Justify the horizon against the disease course, and report the discount rate for costs and outcomes with its source.
- Outcomes. Explain how health effects were measured and valued, including which utility instrument produced the quality adjusted life years (QALYs) and in which population the values were elicited.
- Model rationale and structure. Describe the model type (decision tree, Markov model, partitioned survival, microsimulation), its health states, cycle length, and the reasoning behind the structure, with a diagram.
- Inputs and their sources. Every parameter needs a value, a range or distribution, and a source, normally in a parameter table. Undocumented inputs are the single most common reviewer complaint we see in cost-effectiveness work.
- Uncertainty analysis. Report deterministic sensitivity analyses, typically as a tornado diagram, and probabilistic sensitivity analysis with cost-effectiveness acceptability curves, plus scenario analyses for structural assumptions.
Results, discussion, and disclosures
Report disaggregated costs and outcomes for each comparator, incremental results with the ICER, and the uncertainty results with equal prominence to the base case. The discussion addresses generalizability, limitations, and how findings relate to prior evaluations. Funding sources and conflicts of interest are mandatory items, and their absence is treated as a red flag rather than an oversight.
Trial based and model based evaluations: same checklist, different pressure points
Although CHEERS 2022 unified the checklist, reviewers stress different items by study type. For trial based evaluations, the pressure points are the handling of missing data, protocol driven resource use that would not occur in practice, and the mismatch between trial follow-up and the decision relevant time horizon, which usually forces extrapolation that must be reported as modeling. For model based evaluations, scrutiny lands on structural assumptions, the justification for the chosen model type, the sources and pooling of clinical effectiveness inputs, and the credibility of long term extrapolation from short term data, particularly survival extrapolation, where the choice of parametric distribution can move the ICER more than any single input. Reporting the tested alternatives and the rationale for the selected curve is not optional detail; it is the analysis.
Transferability: reporting for the market you actually target
Economic evaluations travel badly. Unit costs, treatment pathways, comparator availability, and utility values are all jurisdiction specific, and a model built for one market needs documented local adaptation for another. For teams working across India and the Gulf this is a live issue: Saudi Arabia's move toward mandatory economic evaluation in pricing and reimbursement raises the standard for locally credible inputs, and Indian payer contexts differ again. CHEERS 2022 supports this through its setting and location item and its heterogeneity items, but the practical discipline is to report inputs in enough granularity that a reader can substitute local values and re-run the logic. A parameter table that mixes sources without stating which country each cost came from fails that test.
The reviewer comments we see most often
- The abstract omits the ICER, the perspective, or the comparator.
- The discount rate is stated without a source, or differs from the reference case of the target jurisdiction without justification.
- Utility values are cited to a paper that measured a different population or used a different instrument than stated.
- The tornado diagram exists but the text never discusses which parameters drive results.
- Probabilistic results are reported without the cost-effectiveness acceptability curve, or the curve appears without the willingness to pay range being justified.
- The funding and conflict statements are missing, which in health economics is read as concealment rather than oversight.
Why this matters beyond journals
HTA bodies increasingly reference CHEERS 2022 when screening manufacturer submissions, and mandatory economic evaluation requirements in markets such as Saudi Arabia make disciplined reporting a market access asset, not an academic nicety. A model reported to CHEERS standards moves between a journal manuscript, an HTA submission, and a global value dossier with minimal rework, which is exactly how evidence budgets should behave.
How EvySaif builds and reports economic evaluations
Our health economists and clinician writers build models and report them to CHEERS 2022 from the first draft, with complete parameter tables, pre-specified analysis plans, and uncertainty analysis designed in rather than bolted on. If your team has a model that needs publication quality reporting, or a study that needs building from the question up, see our economic modeling services or get in touch.