Can decisionmakers rely on health economic evaluations Can decisionmakers rely on health economic evaluations? A review of studies assessing the quality of published health economic evaluations Nathalie Dourdin PhD, Monika Wagner PhD, Peter Melnyk PhD and Donna Rindress PhD BioMedCom Consultants inc., Montréal, QC, Canada Issues pertaining to the quality of published HE evaluations were identified by determining how many QA studies reported a given issue as a problem in 20% or more of the HE evaluations they reviewed. When a study mentioned a quality criterion as an issue, the study was included in the percentage calculation regardless of the reason for mention (e.g. not clear, not stated, not justified, etc.,). The proportions of QA studies that identified a specific quality issue were then calculated. Quality issues were grouped in clusters as follows: Outcome measures, valuation of health outcomes Types of costs and resources included and year of costing Methodologies for modeling, validation of model, assumptions Sensitivity analyses and CEAC (cost effectiveness acceptability curve) Incremental analyses, calculation errors, wrongful use of efficacy/effectiveness Potential biases and limitations Sources of funding and disclosure of potential conflicts of interest BACKGROUND & OBJECTIVE Health economic (HE) evaluations are intended to provide decisionmakers with information on the comparative efficiency of medical technologies. The quality of an HE study is critical to the useful application of its findings. There are a number of different guidelines and checklists available in the public domain on the conduct and reporting of HE and outcomes research. Adoption of guidelines should help ensure a high degree of rigour and standardization among HE evaluations. There are currently 74 guidelines for the conduct and reporting of HE evaluations (published and public domain). The objective of this work is to review studies assessing the quality of published HE evaluations (QA studies) and to investigate whether quality has improved over time with the use of guidelines. The most commonly reported quality criteria with issues cited by QA studies were: Perspective Sensitivity analyses/uncertainty Discounting Types of costs included Source of funding/conflict of interest Among 68 studies included, only 15 reported on the change in quality of HE evaluations following guideline publication. 11 found evidence that the quality of studies is improving 4 found no improvement over time and sub-optimal adherence to guidelines CONCLUSION Despite a wealth of guidelines, evidence for their impact on the quality of published health economic studies is mixed. Some reviews of health economic evaluations found evidence that the quality of studies is improving. Other reviews found no or only modest improvement over time and sub-optimal adherence to guidelines. Outcome measures for quality of HE studies varied significantly across all these studies and were usually qualitative in nature. FUTURE DIRECTIONS We need standardized guidelines to promote more consistent level of quality of HE publications. This is not sufficient, use and reinforcement by journals publishing HE evaluations (for both reviewers and authors) is needed. We also need more standardized and quantitative measures of quality. METHODS Literature searches Full-text published HE guidelines and studies assessing the quality of HE evaluations were collected from available public domain sources, including PubMed. 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Stone PW, Schackman BR, Neukermans CP, Olchanski N, Greenberg D, Rosen AB, et al. Lancet Infect Dis. 2005;5(6):383-91. RESULTS 68 QA studies met the inclusion criteria; 50 published after 2000 Studies used various tools for assessing quality as well as different ways of reporting the quality assessment Given this heterogeneous approach to QA, some issues may not have been identified in specific assessments Of the studies published after 2000, 39 different approaches were used to measure quality BioMedCom, Pure and Applied Intelligence BioMedCom, L’intelligence en action