OBJECTIVES: Numerous systematic reviews of economic evaluations (SREEs) have been performed to examine the value for money of cancer screening. However, the evidence and the quality of these SREEs has not been systematically assessed. This study aimed to review and to summarize the evidence in SREEs of cancer screening, their methodological quality as well as policy and research recommendations, to examine how well they can inform decisions.

METHODS: We performed systematic searches on four bibliographic databases (Medline, Embase, EconLit, and the NHS Economic Evaluation Database) in June 2022. Two independent researchers screened the titles / abstracts, followed by full texts. We included SREEs on cancer screening published within 2012-2022. We examined the SREEs on the extent of reporting and evaluated their methodological quality using the AMSTAR-2 checklist.

RESULTS: Of 766 unique articles screened, 30 SREEs were included. The SREEs examined screening for breast (23%), colorectal (23%), gastric (10%), liver cancers (10%) and 5 other cancers, using imaging methods (80%), laboratory testing (57%) or physical examinations (13%) in the general population (60%), hospital (10%), primary care (7%) or community (3%). While most SREEs reported economic evaluation methodologies, <50% reported screening uptake / adherence (37%) and none discussed equity issues. AMSTAR-2 ratings ranged 31-85%; most SREEs had duplicate screenings of articles (87%) but only a minority (6.7%) reported the funding sources of the included EEs. While majority SREEs were able to conclude on the relative cost-effectiveness of cancer screening, they also recommended further studies to address the uncertainty of evidence and lack of generalizability of findings to other settings.

CONCLUSIONS: SREEs of cancer screening ranged widely in completeness of reporting and methodological quality. In addition, they may not adequately address all policy concerns e.g., implications on equity. Future SREEs and EEs should strive to address these gaps.