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Quality of health economic evaluations in emergency medicine journals: a systematic review

  • Original Research
  • Published:
Canadian Journal of Emergency Medicine Aims and scope Submit manuscript

Abstract

Objective

Health economic evaluations are used in decision-making regarding resource allocation and it is imperative that they are completed with rigor. The primary objectives were to describe the characteristics and assess the quality of economic evaluations published in emergency medicine journals.

Methods

Two reviewers independently searched 19 emergency medicine-specific journals via Medline and Embase from inception until March 3, 2022. Quality assessment was completed using the Quality of Health Economic Studies (QHES) tool, and the primary outcome was the QHES score out of 100. Additionally, we identified factors that may contribute to higher-quality publications.

Results

7260 unique articles yielded 48 economic evaluations that met inclusion criteria. Most studies were cost–utility analyses and of high quality, with a median QHES score of 84 (interquartile range, IQR: 72, 90). Studies based on mathematical models and those primarily designed as an economic evaluation were associated with higher quality scores. The most commonly missed QHES items were: (i) providing and justifying the perspective of the analysis, (ii) providing justification for the primary outcome, and (iii) selecting an outcome that was long enough to allow for relevant events to occur.

Conclusions

The majority of health economic evaluations in the emergency medicine literature are cost–utility analyses and are of high quality. Decision analytic models and studies primarily designed as economic analyses were positively correlated with higher quality. To improve study quality, future EM economic evaluations should justify the choice of the perspective of the analysis and the selection of the primary outcome.

Abstrait

Objectifs

Les évaluations économiques de la santé sont utilisées dans la prise de décisions concernant l’affectation des ressources et il est impératif qu’elles soient réalisées avec rigueur. Les principaux objectifs étaient de décrire les caractéristiques et d’évaluer la qualité des évaluations économiques publiées dans les revues de médecine d’urgence.

Méthodes

Deux examinateurs ont effectué une recherche indépendante dans 19 revues spécialisées en médecine d’urgence au moyen de Medline et d’Embase, du début jusqu’au 3 mars 2022. L’évaluation de la qualité a été effectuée à l’aide de l’outil Quality of Health Economic Studies (QHES), et le résultat principal a été la note de l’QHES sur 100. De plus, nous avons relevé des facteurs qui pourraient contribuer à des publications de meilleure qualité.

Résultats

7260 articles uniques ont produit 48 évaluations économiques qui répondaient aux critères d’inclusion. La plupart des études étaient des analyses coût-utilité et de haute qualité, avec un score médian de l’EPQE de 84 (plage interquartile, IQR : 72,90). Les études fondées sur des modèles mathématiques et celles conçues principalement comme une évaluation économique ont été associées à des notes de qualité supérieure. Les éléments les plus souvent omis de l’EPQH étaient : i) fournir et justifier la perspective de l’analyse, ii) fournir une justification pour le résultat principal, et iii) choisir un résultat qui était suffisamment long pour permettre aux événements pertinents de se produire.

Conclusions

La majorité des évaluations économiques de la santé dans la littérature sur la médecine d’urgence sont des analyses coût-utilité et sont de grande qualité. Les modèles d’analyse décisionnelle et les études principalement conçus comme des analyses économiques ont été positivement corrélés avec une qualité supérieure. Pour améliorer la qualité des études, les futures évaluations économiques des ME devraient justifier le choix de la perspective de l’analyse et le choix du résultat principal

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Funding

This study was funded by a Grant from the Department of Emergency Medicine, The Ottawa Hospital. Ottawa, ON, Canada.

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Authors and Affiliations

  1. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada

    Shawn Chhabra, Austin Cameron & Krishan Yadav

  2. Division of Neonatal-Perinatal Medicine, IWK Health Centre, Halifax, NS, Canada

    Austin Cameron

  3. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Kednapa Thavorn

  4. Health Sciences Library, University of Ottawa, Ottawa, ON, Canada

    Lindsey Sikora

  5. Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

    Kednapa Thavorn & Krishan Yadav

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Chhabra, S., Cameron, A., Thavorn, K. et al. Quality of health economic evaluations in emergency medicine journals: a systematic review. Can J Emerg Med 25, 676–688 (2023). https://doi.org/10.1007/s43678-023-00535-w

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