Health Economic Evaluations Incorporating Broader Perspectives: A Targeted Literature Review

OBJECTIVES: Traditional economic evaluations inform healthcare decision-making by comparing usually direct medical costs and health outcomes of different health interventions. However, there is growing recognition of the need to incorporate broader perspectives, including ecological impacts, social equity, and long-term societal benefits. The purpose of this review is to identify and evaluate health economic evaluations (HEEs) that incorporate broader perspectives in different ways. By examining these HEEs, the review aims to highlight current methodologies, common practices, and gaps in the literature, thus understanding the integration of wider societal impacts into economic analyses.

METHODS: To conduct this review, a targeted literature search was performed on PubMed, Medline, and Web of Science databases using relevant MeSH terms and keywords. Screening criteria focused on full economic evaluations of health interventions published since 2014 in peer-reviewed English-language journals. Dual independent reviewers screened titles and abstracts, followed by a full-text review, with discrepancies resolved by a third reviewer. Data extraction encompassed study characteristics, economic evaluation details, and integration of broader perspectives such as ecological and equity considerations, employing the CHEERS checklist for quality assessment.

RESULTS: From 251 initial references, 14 HEEs met inclusion criteria, predominantly from Europe and the United States. These studies employed diverse methodologies including Distributional Cost-Effectiveness Analysis (DCEA) and Extended Cost-Effectiveness Analysis (ECEA) to incorporate broader perspectives, albeit with significant variability across studies. While methods for equity assessment show some standardisation, methodologies for evaluating ecological impacts require further development and uniformity.

CONCLUSIONS: In conclusion, this review provides valuable insights into the current state of integrating broader societal impacts into HEEs. It underscores progress and persistent gaps, particularly in standardising ecological impact assessments. Moving forward, there is a crucial need for enhanced methodological frameworks and broader geographic representation to strengthen the relevance and comprehensiveness of economic analyses in healthcare decision-making across diverse contexts.