Abstract

We read with interest the review by Ruggeri et al. [1] on the generalizability of economic evaluations conducted in Italy. It is crucial for a critical review to be also systematic and complete. However, we noticed that despite the number of articles and related information included in the critical review, some relevant indexed and peer-reviewed publications had been omitted. As an example, we report a list of full articles [2,3,4,5,6,7,8,9,10,11] that, according to the criteria specified by Ruggeri et al., we believe should have been included in their review. All these articles refer to full economic evaluations (cost-effectiveness, cost-utility, cost-benefit analyses) as can be gathered by the title or the keywords. All these studies were conducted in the Italian health care setting, and were published between 1995 and 2013 in English or Italian language. Furthermore, most of these articles can be retrieved from the PubMed database [3,4,5,6,7,10,11]. Apparently, from Figure 1 in the article by Ruggeri et al, it appears that many other articles could have been excluded for nonrelevant or nonclear reasons. Thirty citations were excluded for “online access limitations”: this limitation could have reduced the access to relevant articles that could have been found using alternative approaches, for example, searching other databases, scientific libraries, or directly contacting the authors. The word “online” apparently suggests that none of these alternative ways has been tried. Furthermore, the authors do not specify why 3940 citations out of 4400 abstracts screened were excluded. Then, 309 full-text articles were excluded for not totally clearly stated reasons: in particular, we think that it should be clarified what differentiates the “not relevant study design” citations (125 articles) from the other excluded “cost-consequences analysis,” “not full economic evaluations,” “observational studies,” “retrospective studies,” and “budget impact analysis” citations.

Therefore, according to the objectives and methods specified in the article by Ruggeri et al., we believe that articles relevant to the authors’ objective have not been scrutinized although these should have been included and assessed to provide an adequate judgment on the generalizability of economic evaluations in Italy. For these reasons, we think that the conclusions of Ruggeri et al. should be considered cautiously.