(184) The Quality of Reporting Methods and Results of Cost-Effectiveness Analyses in India: A Methodological Systematic Review

Publication Number: 858

Background: Cost-effectiveness analysis has been recognized as an important tool to determine the efficiency of healthcare interventions and services. There is limited evidence on the impact of health insurance on the health and economic well-being of Indian beneficiaries along with uncertainty in the execution of such economic evaluations in India, due to some hesitancy for the adoption of developed countries guidelines. Hence it is crucial to evaluate the reporting of methods and results of cost-effectiveness analyses and establish their validity. We describe and examine reporting characteristics of methods and results of cost-effectiveness analyses conducted in India.

Objectives: 1) To identify cost-effectiveness studies conducted in India and report their characteristics.
2) To assess the quality of the studies conducted in India using cost-effectiveness analysis.

Methods: A systematic search was performed using PubMed, Cochrane CENTRAL, and Google Scholar from the inception to 30th November 2021 to identify cost-effectiveness studies conducted in India. A combination of keywords, MeSH terms on cost-effectiveness, and India were used with Boolean operators. The study included all the cost-effectiveness analyses conducted that have used quality-adjusted life years (QALYs) as the outcome measures. Two reviewers independently extracted data using a self-developed item data collection form designed to assess reporting details of the studies. Quality of studies was evaluated using the Consensus on Health Economic Criteria (CHEC) and Quality of health economic studies (QHES) checklists. The collected data were analyzed descriptively.

Results: A total of 48 studies were included. Very few studies (7, 14.5%) have reported working from protocol. Around 85% of studies were model based, of which the Markov model was frequently reported. Most study interventions were categorized as therapeutic (45.83%), and some studies (35.41%) considered an active alternative as the comparator. The effectiveness of data was derived from a single study in 19 (39.58%) reports, and only a few (15, 31.25%) used evidence synthesis-based estimates. Very few studies (2, 4.16%) reported a complete description of methods for QALY calculation. Most of the studies (34, 70.8%) reported that the study intervention produced "most costs and more QALYs" than the comparator. Most of studies (39, 81.25%) were reported favorable conclusions. Most articles showed moderate quality when assessed with the CHEC (68.75%) and QHES (45.83%) checklists. In CHEC, most studies have not mentioned the costs of physical units (39, 81.3%) and are not valued appropriately (27, 56.3%). In contrast, in QHES many studies did not mention about study objective (26, 54.2%), data abstraction (32, 66.7%) leads to a decline in quality of studies.

Conclusions: Several crucial components of techniques and outcomes are commonly lacking in published cost-effectiveness analyses. It is impossible to judge the validity of research findings and conclusions without a complete and comprehensive description of how studies were organized and executed.