Twenty years of health care economic analysis in Spain: are we doing well?

Abstract

The rising demand for health care, together with the scarce available resources, has increased the use of economic analysis as a support tool for policy making. The objective of this study was to make a description of economic evaluation studies carried out in Spain and published during the last 20 years, and to assess their quality. A systematic bibliographic search was made in the main biomedical databases. Full economic evaluation studies made in Spain comparing two or more health care alternatives were included. Statistical analyses included a descriptive analysis, the assessment of the association between pairs of variables, and a homogeneity analysis. A total of 87 studies were included in the review. According to the methodology, the technique most frequently used was cost-effectiveness analysis. In most cases, some weaknesses could be pointed out: absence of any objective directly linked to the decision-making process, a non-explicit perspective, no inclusion of indirect costs, or clinical and economical data not concurrently collected. A continuing challenge for health care economic analysis in Spain is to follow methodological guidelines and reporting conventions, to improve the dissemination of research, as well as to use more sophisticated economic analysis techniques, and to publish in international journals.

The use of cost per life year gained as a measurement of cost-effectiveness in Spain: a systematic review of recent publications

“…Third, 97% of studies conducted some form of sensitivity analysis, an essential requirement for any good economic evaluation, compared with only 30-68% [1,4] of past reviews. And fourth, although only 47% of studies stated the source of financing, this is greater than the 29% found in past reviews [4]. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 estimators, allows data to be described with reduced weighting of outliers.…”

“…1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 The methodology used by the majority of studies assessed satisfied most of the general methodological aspects considered to represent good practice in international recommendations [3,8,9,10,11]. Compared with previous reviews [1,4] the number and quality of published Spanish health economic evaluations seems to have improved over times, and some deficiencies found in previous reviews seem to have been solved. Analysis of the methodological quality of the studies published since 2003, showed that 86% (30 out of 35) were rated as (code++ or code +), showing the possible influence of previously published reviews in 2002 [1,12] that may have led to greater methodological rigor.…”

“…First, 82% of studies reviewed stated the perspective of the evaluation, compared to 28 and 43%, respectively, in previous reviews [1,4]. Second, the incremental cost and LYG differences are shown together with incremental ratios in 84% of studies.…”

“…In the Results section we now state: "Compared to previous systematic Spanish reviews [1,4], some methodological aspects seem to have improved. First, 82% of studies reviewed stated the perspective of the evaluation, compared to 28 and 43%, respectively, in previous reviews [1,4].…”

“…Economic evaluation of health technologies has been increasing over recent decades in Spain, as evidenced by systematic reviews of Spanish economic healthcare evaluations [1, 4,5]. However, these studies also point out some methodological aspects to be improved, including the definition of the perspective used in the study or the inclusion of sensitivity analyses, among others.…”