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A Systematic Review of the State of Economic Evaluation for Health Care in India

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Abstract

Background and objective

Economic evaluations are one of the important tools in policy making for rational allocation of resources. Given the very low public investment in the health sector in India, it is critical that resources are used wisely on interventions proven to yield best results. Hence, we undertook this study to assess the extent and quality of evidence for economic evaluation of health-care interventions and programmes in India.

Methods

A comprehensive search was conducted to search for published full economic evaluations pertaining to India and addressing a health-related intervention or programme. PubMed, Scopus, Embase, ScienceDirect, and York CRD database and websites of important research agencies were identified to search for economic evaluations published from January 1980 to the middle of November 2014. Two researchers independently assessed the quality of the studies based on Drummond and modelling checklist.

Results

Out of a total of 5013 articles enlisted after literature search, a total of 104 met the inclusion criteria for this systematic review. The majority of these papers were cost-effectiveness studies (64 %), led by a clinician or public-health professional (77 %), using decision analysis-based methods (59 %), published in an international journal (80 %) and addressing communicable diseases (58 %). In addition, 42 % were funded by an international funding agency or UN/bilateral aid agency, and 30 % focussed on pharmaceuticals. The average quality score of these full economic evaluations was 65.1 %. The major limitation was the inability to address uncertainties involved in modelling as only about one-third of the studies assessed modelling structural uncertainties (33 %), or ran sub-group analyses to account for heterogeneity (36.5 %) or analysed methodological uncertainty (32 %).

Conclusion

The existing literature on economic evaluations in India is inadequate to feed into sound policy making. There is an urgent need to generate awareness within the government of how economic evaluation can inform and benefit policy making, and at the same time build capacity of health-care professionals in understanding the economic principles of health-care delivery system.

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Acknowledgments

We are grateful to the assistance provided by the Mrs. Neelima Chadha from the library of Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh; and staff of the Advanced Centre for Evidence Based Child Health in the Department of Paediatrics, PGIMER, Chandigarh, India, who provided valuable inputs to finalize the search strategy for the present review and helped in retrieving the necessary papers.

Author contributions

Conception of the idea: SP, SJ, IG. Searching of data bases and reviewing of the selected studies: ASC, BA. Arbitration in case of discrepancy between the authors who reviewed the studies: SP. Data analysis: ASC, BA. Writing the first draft: ASC, SP. Critical inputs in the draft: all authors.

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Authors and Affiliations

  1. School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India

    Shankar Prinja & Akashdeep Singh Chauhan

  2. The George Institute for Global Health, Camperdown, NSW, 2050, Australia

    Blake Angell & Stephen Jan

  3. Health Policy Research Unit, Institute of Economic Growth, University of Delhi Enclave, Delhi, 110007, India

    Indrani Gupta

  4. Sydney Medical School, University of Sydney, Sydney, Australia

    Stephen Jan

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  1. Shankar Prinja
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Correspondence to Shankar Prinja.

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Shankar Prinja, Akashdeep Singh Chauhan, Blake Angell, Indrani Gupta and Stephen Jan declare no competing interest.

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Prinja, S., Chauhan, A.S., Angell, B. et al. A Systematic Review of the State of Economic Evaluation for Health Care in India. Appl Health Econ Health Policy 13, 595–613 (2015). https://doi.org/10.1007/s40258-015-0201-6

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