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. 2026 Mar;45(6-7):e70352.
doi: 10.1002/sim.70352.

Meta-Analysis of Cost-Effectiveness

Heejung Bang  1 , Hongwei Zhao  2
Affiliations

Meta-Analysis of Cost-Effectiveness

Heejung Bang et al. Stat Med. 2026 Mar.

Abstract

Systematic review and meta-analysis are widely accepted approaches for evaluating treatment effectiveness. Meta-analysis generally addresses statistical aspects of systematic reviews, such as the pooling of treatment effect sizes, assessment of heterogeneity, and statistical inference. To complement treatment effectiveness, cost-effectiveness is often conducted to encompass both clinical and economic perspectives. However, there are few statistical methods proposed for meta-analyses of cost-effectiveness, and none is used widely. In fact, meta-analysis is currently not encouraged for cost-effectiveness due to methodological and statistical complexities. In this paper, we propose simple meta-analytic methods for cost-effectiveness, which may serve as a starting point for future work. We illustrate the methods using two examples from systematic reviews on wound interventions and mental illness.

Keywords: bootstrap wedge; cost‐effectiveness analysis; cost‐effectiveness plane; health economics; incremental cost‐effectiveness ratio (ICER); systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Real examples—Tricco study. Upper figure: Rectangle is a 95% confidence interval box for the effect and cost. X indicates the point estimate. Size of the bubble is proportional to the study size (i.e., sample size). Solid line represents the summary incremental cost‐effectiveness ratio (ICER). Lower figure: 95% confidence interval/arc for ICER. CB denotes clockwise bound, and CCB denotes counterclockwise bound. Dots represent 500 bootstrap replicates. Note that the ranges of axes are different in the upper and lower figures. See Table 1 for original data and Table 2 for numeric results.
FIGURE 2
FIGURE 2
Real examples—Dewa study.
See this image and copyright information in PMC

References

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