Abstract
BackgroundStudies published in non-English languages are systematically missing in systematic reviews of growth and quality of economic evaluations of health care. The aims of this study were: to characterize German evaluations, published in English or German-language, in terms of various key parameters; to investigate methods to derive quality-of-life weights in cost-utility studies; and to examine changes in study characteristics over the years.MethodsWe conducted a country-specific systematic review of the German and English-language literature of German economic evaluations (assessment of or application to the German health care system) published 1990–2004. Generic and specialized health economic databases were searched. Two independent reviewers verified fulfillment of inclusion criteria and extracted study characteristics.ResultsThe fulltexts of 730 articles were reviewed of which 283 fulfilled all entry criteria. 32% of included studies were published in German-language. 51% of studies evaluated pharmaceuticals and 63% were cost-effectiveness analyses. Economic appraisals concentrate on few disease categories and important health areas are strongly underrepresented. Declaration of sponsorship was associated with article language (49% English articles vs. 29% German articles, p < 0.001). The methodology used to obtain quality-of-life weights in published cost-utility studies was very diverse, poorly reported and most studies did not use German patients' or community health state valuations.ConclusionMany of the German-language evaluations included in our study are likely to be missing in international reviews and may be systematically different from English-language reviews from Germany. Lack of transparency and adherence to recommended reporting practices constitute a serious problem in German economic evaluations.
Highlights
Studies published in non-English languages are systematically missing in systematic reviews of growth and quality of economic evaluations of health care
Many of the German-language evaluations included in our study are likely to be missing in international reviews and may be systematically different from Englishlanguage reviews from Germany
Lack of transparency and adherence to recommended reporting practices constitute a serious problem in German economic evaluations
Summary
Studies published in non-English languages are systematically missing in systematic reviews of growth and quality of economic evaluations of health care. In a recent analysis of cost data in economic evaluations conducted alongside randomized controlled trials, only 37% of the reviewed evaluations presented a cost-effectiveness ratio or estimated net benefits and only 57% of these reported the uncertainty of this statistic [6] These reviews have covered the English-language literature only, and analyses published in languages other than English are systematically missing. The aim of this study was to overcome this gap and to 1) analyze in which journals and in which language German economic evaluations have been published; 2) describe the characteristics of the studies in terms of various key parameters, such as type of evaluation, study design, covered diseases, study perspective, funding sources and others; 3) examine changes in study and publication characteristics over the years and 4) investigate methods to derive quality-of-life weights in cost-utility. While our study included all types of full economic evaluations, we paid special attention to cost-utility-analyses, the methods used to derive utilities for calculation of quality-adjusted life years (QALYs) in published studies and, in particular, whether preferences have been elicited from German patients or community members
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