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Review
. 2017 Oct;35(10):1007-1033.
doi: 10.1007/s40273-017-0531-3.

Reporting and Analysis of Trial-Based Cost-Effectiveness Evaluations in Obstetrics and Gynaecology

Mohamed El Alili  1 , Johanna M van Dongen  2 , Judith A F Huirne  3 , Maurits W van Tulder  2 , Judith E Bosmans  2
Affiliations
Review

Reporting and Analysis of Trial-Based Cost-Effectiveness Evaluations in Obstetrics and Gynaecology

Mohamed El Alili et al. Pharmacoeconomics. 2017 Oct.

Abstract

Background and objectives: The aim was to systematically review whether the reporting and analysis of trial-based cost-effectiveness evaluations in the field of obstetrics and gynaecology comply with guidelines and recommendations, and whether this has improved over time.

Data sources and selection criteria: A literature search was performed in MEDLINE, the NHS Economic Evaluation Database (NHS EED) and the Health Technology Assessment (HTA) database to identify trial-based cost-effectiveness evaluations in obstetrics and gynaecology published between January 1, 2000 and May 16, 2017. Studies performed in middle- and low-income countries and studies related to prevention, midwifery, and reproduction were excluded.

Data collection and analysis: Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) statement (a modified version with 21 items, as we focused on trial-based cost-effectiveness evaluations) and the statistical quality was assessed using a literature-based list of criteria (8 items). Exploratory regression analyses were performed to assess the association between reporting and statistical quality scores and publication year.

Results: The electronic search resulted in 5482 potentially eligible studies. Forty-five studies fulfilled the inclusion criteria, 22 in obstetrics and 23 in gynaecology. Twenty-seven (60%) studies did not adhere to 50% (n = 10) or more of the reporting quality items and 32 studies (71%) did not meet 50% (n = 4) or more of the statistical quality items. As for the statistical quality, no study used the appropriate method to assess cost differences, no advanced methods were used to deal with missing data, and clustering of data was ignored in all studies. No significant improvements over time were found in reporting or statistical quality in gynaecology, whereas in obstetrics a significant improvement in reporting and statistical quality was found over time.

Limitations: The focus of this review was on trial-based cost-effectiveness evaluations in obstetrics and gynaecology, so further research is needed to explore whether results from this review are generalizable to other medical disciplines.

Conclusions and implications of key findings: The reporting and analysis of trial-based cost-effectiveness evaluations in gynaecology and obstetrics is generally poor. Since this can result in biased results, incorrect conclusions, and inappropriate healthcare decisions, there is an urgent need for improvement in the methods of cost-effectiveness evaluations in this field.

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Conflict of interest statement

Disclosure of potential conflict of interests

ME reports no conflict of interest. JMvD reports no conflict of interest. JEB reports no conflict of interest. JAF has received grants from ZonMw, NOW, Samsung, Celenova and Pelgrem, outside the submitted work. MWT’s institution received research grants from several government research agencies and professional organizations and his travel expenses were covered by organizing professional organizations. He received honoraria for reviewing grant proposals from Swedish and Canadian governmental grant agencies. He has not received any honoraria or travel expenses from the industry.

Ethics approval and informed consent

This was a systematic review of previously published data and therefore does not require ethical approval and/or informed consent.

Funding

None.

Figures

Fig. 1
Fig. 1
Flow chart for inclusion of studies. CEA cost-effectiveness analysis, CUA cost-utility analysis, HTA Health Technology Assessment database, NHSEED NHS Economic Evaluation Database
See this image and copyright information in PMC

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