Abstract
Economic evaluations help decision-makers faced with tough decisions on how to allocate resources. Systematic reviews of economic evaluations are useful as they allow readers to assess whether interventions have been demonstrated to be cost effective, the uncertainty in the evidence base, and key limitations or gaps in the evidence base. The synthesis of systematic reviews of economic evaluations commonly takes a narrative approach whereas a meta-analysis is common step for reviews of clinical evidence (e.g. effectiveness or adverse event outcomes). As they are common objectives in other reviews, readers may query why a synthesis has not been attempted for economic outcomes. However, a meta-analysis of incremental cost-effectiveness ratios, costs, or health benefits (including quality-adjusted life years) is fraught with issues largely due to heterogeneity across study designs and methods and further practical challenges. Therefore, meta-analysis is rarely feasible or robust. This commentary outlines these issues, supported by examples from the literature, to support researchers and reviewers considering systematic review of economic evidence.
Highlights
Cost-effectiveness analysis evaluates and compares the expected costs and health benefits of two or more healthcare interventions and supports decision-makers in assessing value for money
Systematic reviews of economic evaluations allow readers to consider whether healthcare interventions have been demonstrated to be cost effective, uncertainty in the evidence base and key limitations of the evidence
This paper aims to briefly summarise why conducting a meta-analysis of economic evaluation outcomes, focusing on incremental cost-effectiveness ratios, costs, and quality-adjusted life years, is usually inappropriate
Summary
Cost-effectiveness analysis evaluates and compares the expected costs and health benefits of two or more healthcare interventions and supports decision-makers in assessing value for money. Key complications in synthesising costeffectiveness outcomes In the sections below, we detail the key factors that contribute to a synthesis of cost-effectiveness outcomes being inappropriate. Note that this is not a critique of economic evaluation; the nature of cost-effectiveness analysis, decision-analytic modelling, often necessitates combining data from different sources and assumptions to be made by the analyst. This is often done well, including a detailed exploration of the uncertainty. It does create challenges when synthesising across the wider evidence base
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