Costing evidence for health care decision-making in Austria: A systematic review

Abstract

BackgroundWith rising healthcare costs comes an increasing demand for evidence-informed resource allocation using economic evaluations worldwide. Furthermore, standardization of costing and reporting methods both at international and national levels are imperative to make economic evaluations a valid tool for decision-making. The aim of this review is to assess the availability and consistency of costing evidence that could be used for decision-making in Austria. It describes systematically the current economic evaluation and costing studies landscape focusing on the applied costing methods and their reporting standards. Findings are discussed in terms of their likely impacts on evidence-based decision-making and potential suggestions for areas of development.MethodsA systematic literature review of English and German language peer-reviewed as well as grey literature (2004–2015) was conducted to identify Austrian economic analyses. The databases MEDLINE, EMBASE, SSCI, EconLit, NHS EED and Scopus were searched. Publication and study characteristics, costing methods, reporting standards and valuation sources were systematically synthesised and assessed.ResultsA total of 93 studies were included. 87% were journal articles, 13% were reports. 41% of all studies were full economic evaluations, mostly cost-effectiveness analyses. Based on relevant standards the most commonly observed limitations were that 60% of the studies did not clearly state an analytical perspective, 25% of the studies did not provide the year of costing, 27% did not comprehensively list all valuation sources, and 38% did not report all applied unit costs.ConclusionThere are substantial inconsistencies in the costing methods and reporting standards in economic analyses in Austria, which may contribute to a low acceptance and lack of interest in economic evaluation-informed decision making. To improve comparability and quality of future studies, national costing guidelines should be updated with more specific methodological guidance and a national reference cost library should be set up to allow harmonisation of valuation methods.

Cost-of-illness studies in nine Central and Eastern European countries

“…The study perspective was reported in 78%, the approach to valuing indirect costs in 77%, costing method in 64%, at least one unit cost in 42%, and method for valuing informal care in 31% of the studies. A recent review of economic evaluations in Austria found that the study perspective and reference year were not reported by 60% and 25% of the studies, respectively [ 13 ]. Differences may be explained by inclusion of non-peer-reviewed or grey literature (e.g., economic evaluation reports from national health technology assessment agencies) and of other forms of economic evaluations in the study by Mayer et al The review by Mayer et al included 93 (partial and full) economic evaluations, 14 of which were cost-of-illness analyses.…”

“…Differences may be explained by inclusion of non-peer-reviewed or grey literature (e.g., economic evaluation reports from national health technology assessment agencies) and of other forms of economic evaluations in the study by Mayer et al The review by Mayer et al included 93 (partial and full) economic evaluations, 14 of which were cost-of-illness analyses. Out of the 93 included studies, 23 were not indexed according to the Journal Citation Reports (Social) Sciences Edition and 12 were non-peer-reviewed reports [ 13 ].…”

“…Methodological deficiencies, such as the lack of reporting either on the three distinct phases of costing (identifying the relevant cost items, measuring the use of the identified resources, and placing a value on these cost items) [ 46 ], or other important characteristics such as the perspective of the study, related to the production function (direct and indirect costs) were the leading causes of shortcomings in comparability. However, no specific costing guidelines for health care interventions are available in these countries, and except in Austria, there is no national cost database available, providing some kind of unit cost data in a collected form [ 13 , 47 , 48 ]. Another important difficulty in costing relates to the different Managed Entry Agreements (MEA), such as price volume agreements, discounts, outcome guarantees, and many more, in the reimbursement of the health technologies in the different countries [ 49 , 50 ].…”

“…Until now, several systematic reviews of COI studies have been conducted; however, most of them were focusing on one specific disease. Few reviews targeted a single specific cost item or component, such as informal care, direct medical costs, productivity loss, a specific geographic area, or a specific methodological aspect [ 10 – 13 ]. Nonetheless, COI studies from CEE countries have not been reviewed to date, with the exception of Austria [ 13 ].…”

Best-worst scaling to assess the most important barriers and facilitators for the use of health technology assessment in Austria

“…Secondly, the list of potential participants was complemented with institutions and contacts provided by national experts of the Austrian health care system, including members of the Department of Health Economics at the Medical University of Vienna. Additional stakeholders were also informed by institutions identified in a recent systematic literature review of published economic evaluations in Austria [26,27]. Thirdly, relevant experts were selected based on the literature review conducted for the identification of Austriaspecific barriers and facilitators.…”