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Quality Assessment of Published Health Economic Analyses from South America

Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago, Chile; Research Fellow, PharmIdeas Research and Consulting Inc., Oakville, ON, Canada

Michael Iskedjian, MSc, President

PharmIdeas Research and Consulting Inc.

Thomas R Einarson, PhD, Associate Professor

Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Vice-President, PharmIdeas Research and Consulting Inc.

Reprints: Dr. Einarson, Leslie Dan Faculty of Pharmacy, University of Toronto, 19 Russell St., Toronto, ON M5S 2S2, Canada, fax 416/978-8511, t.einarson{at}utoronto.ca

BACKGROUND: Health economic analyses have become important to healthcare systems worldwide. No studies have previously examined South America's contribution in this area.

OBJECTIVE: To survey the literature with the purpose of reviewing, quantifying, and assessing the quality of published South American health economic analyses.

METHODS: A search of MEDLINE (1990-December 2004), EMBASE (1990-December 2004), International Pharmaceutical Abstracts (1990-December 2004), Literatura Latino-Americana e do Caribe em Ciências da Saúde (1982-December 2004), and Sistema de Informacion Esencial en Terapéutica y Salud (1980-December 2004) was completed using the key words cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-minimization analysis (CMA), and cost-benefit analysis (CBA); abbreviations CEA, CUA, CMA, and CBA; and all South American country names. Papers were categorized by type and country by 2 independent reviewers. Quality was assessed using a 12 item checklist, characterizing scores as 4 (good), 3 (acceptable), 2 (poor), 1 (unable to judge), and 0 (unacceptable). To be included in our investigation, studies needed to have simultaneously examined costs and outcomes.

RESULTS: We retrieved 25 articles; one duplicate article was rejected, leaving 24 (CEA = 15, CBA = 6, CMA = 3; Brazil = 9, Argentina = 5, Colombia = 3, Chile = 2, Ecuador = 2, 1 each from Peru, Uruguay, Venezuela). Variability between raters was less than 0.5 point on overall scores (OS) and less than 1 point on all individual items. Mean OS was 2.6 (SD 1.0, range 1.4-3.8). CBAs scored highest (OS 2.8, SD 0.8), CEAs next (OS 2.7, SD 0.7), and CMAs lowest (OS 2.0, SD 0.5). When scored by type of question, definition of study aim scored highest (OS 3.0, SD 0.8), while ethical issues scored lowest (OS 1.5, SD 0.9). By country, Peru scored highest (mean OS 3.8) and Uruguay had the lowest scores (mean OS 2.2). A nonsignificant time trend was noted for OS (R² = 0.12; p = 0.104).

CONCLUSIONS: Quality scores of health economic analyses articles published in South America were rated poor to acceptable and lower than previous research from other countries. Thus, efforts are needed to improve the reporting quality of these analyses in South America. Future research should examine the region's level of expertise and educational opportunities for those in the field of health economics.

Key Words: health economics, literature analysis, quality assessment, South America

Published Online, May 2, 2006. www.theannals.com, DOI 10.1345/aph.1G296