Quality assessment of economic analyses in pediatric urology

Abstract

Objective: To describe and evaluate economic analyses or economic evaluations in pediatric urologic literature, including study types such as cost-effectiveness analysis, which are increasingly common in the medical literature.

Methods: We performed a systematic literature review of the MEDLINE, EMBASE, and Cochrane databases (1990-2011) to identify economic analyses of pediatric urologic topics. Studies were evaluated using published quality metrics. We examined the analysis type, data sources, perspective, methodology, sensitivity analyses, and the reporting of methods, results, limitations, and conclusions.

Results: We identified 2945 nonduplicated studies, 60 of which met inclusion criteria. Economic analyses of pediatric urologic topics increased in number during the study period, from 1 study (2%) in 1990 to 7 (12%) in 2010 (P <.0001 for trend). The most common types of analyses were cost-effectiveness and cost-minimization (22 each, 37%), typically performed from the payer perspective (26 [43%]). Although 44 (73%) correctly identified the analysis type, only 21 (35%) correctly identified the study perspective. Optimal data sources were used in 7 studies (11%). Appropriate inflationary discounting was used in 17 of 53 (32%). Sensitivity analyses were not reported in 31 of 53 (58%). The descriptions of study methods were adequate in 43 studies (72%), assumptions were adequately reported in 42 (70%), and 37 (62%) adequately discussed limitations.

Conclusion: Although economic analyses are increasing in the pediatric urologic literature, there is a need for standardization in methods and reporting. Future investigations should attempt to follow standardized reporting guidelines and should pay particular attention to reporting of methods and results, including a comprehensive discussion of limitations.

FIGURE 1

Flow diagram for search and selection process for included studies. Title screening and abstract review allowed exclusion of non-urologic topics and studies that were not exclusively pediatric.

FIGURE 2

Graph showing the increasing number of economic analyses in the pediatric urology literature from 1990 to early 2010.