Tools for the Critical Appraisal of Health Economic Analyses: A Scoping Review

OBJECTIVES: Currently, there is no consensus on the ideal tool for evaluating the quality of the evidence obtained from health economic analysis (HEA). Our aim was to identify and compare available tools for the quality evaluation of these studies.

METHODS: We conducted a scoping review to identify tools for the critical appraisal of full HEA, specifically cost-effectiveness, cost-utility and cost-benefit analysis. In January 2023, we searched PubMed, Embase, and Google Scholar, using the keywords "economic evaluation" and "critical appraisal". Tool characteristics, questions and/or recommendations for the evaluation of HEA were extracted using standardized forms. Each statement was categorized into pre-specified domains based on the topics they addressed.

RESULTS: The search yielded 2120 references from which we identified 20 eligible tools. Five were developed for specific clinical contexts. Two tools specified that they were intended to evaluate cost-effectiveness and cost-utility analysis, while others could be used for any type of HEA. All tools were structured as checklists, with yes-or-no or simple answer questions, ranging between 7 and 80 items. In total, we extracted 618 evaluation questions. Modeling parameters and quality of reporting were the most common aspects addressed. Fifteen tools did not provide a clear explanation for the criteria in each question.

CONCLUSIONS: These results highlight variation in the content of identified tools and lack of guidance on how to correctly use most of them. Although identified tools aimed to assess methodological quality, most questions only assessed quality of reporting. The results of this study are being used in the development of a new, more comprehensive, HEA assessment tool.