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

Abstract

Background and ObjectivesThe 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 CriteriaA 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 AnalysisReporting 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.ResultsThe 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.LimitationsThe 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 FindingsThe 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.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-017-0531-3) contains supplementary material, which is available to authorized users.

Challenges in economic evaluations in obstetric care: a scoping review and expert opinion

“…Whereas previous studies 8,9 have focused on assessing the methodological quality of individual EEs in obstetric care using a checklist (e.g. CHEERS Statement), 18 no in‐depth analysis was performed of what makes adherence to guidelines difficult.…”

“…Previous reviews of EE studies in gynaecology and obstetrics, reported problems with adherence to guidelines, 6,7 although improvement over time has been observed 8,9 . However, it was still concluded that improvement of the methodological quality of EEs within the field of obstetrics and gynaecology remained possible and desirable.…”

Taking the Analysis of Trial-Based Economic Evaluations to the Next Level: The Importance of Accounting for Clustering

“…The more alike participants are within a cluster, which is quantified using the intraclass correlation coefficient (ICC), the less new information is provided by a participant belonging to that same cluster. Despite the fact that statistical methods for dealing with clustered data are available and their use in effectiveness studies is well established [ 8 , 15 – 17 ], these methods are hardly used in trial-based economic evaluations [ 5 , 18 ]. In addition, no clear recommendations on how to deal with clustered data are available in pharmacoeconomic guidelines [ 19 ].…”

Costing the impact of interventions during pregnancy in the UK: a systematic review of economic evaluations

“…1 The number of cost-effectiveness evaluations published annually in obstetrics and gynaecology has increased since 2000, with the majority being conducted alongside a clinical trial. 2 …”