Reviewing Transferability in Economic Evaluations Originating From Eastern Europe

Abstract

Objectives: The aim of this study is to analyze the quality and transferability issues reported in published peer-reviewed English-language economic evaluations based in healthcare settings of the Central and Eastern European (CEE) and former Soviet countries.Methods: A systematic search of economic evaluations of healthcare interventions was performed for Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Turkmenistan, Kazakhstan, Lithuania, the former Yugoslav Republic of Macedonia, Republic of Moldova, Romania, the Russian Federation, Serbia, Slovenia, and Ukraine. The included studies were assessed according to their characteristics, quality (using Drummond's checklist), use of local data, and the transferability of inputs and results, if addressed.Results: Most of the thirty-four economic evaluations identified were conducted from a healthcare or payer perspective (74 percent), with 47 percent of studies focusing on infectious diseases. The least frequently and transparently addressed parameters were the items’ stated perspectives, relevant costs included, accurately measured costs in appropriate units, outcomes and costs credibly valued, and uncertainties addressed. Local data were often used to assess unit costs, baseline risk, and resource usage, while jurisdiction-specific utilities were included in only one study. Only 32 percent of relevant studies discussed the limitations of using foreign data, and 36 percent of studies discussed the transferability of their own study results to other jurisdictions.Conclusions: Transferability of the results is not sufficiently discussed in published economic evaluations. To simplify the transferability of studies to other jurisdictions, the following should be comprehensively addressed: uncertainty, impact of influential parameters, and data transferability. The transparency of reporting should be improved.

Cost-of-illness studies in nine Central and Eastern European countries

“…As Gao et al stated, confirming the transferability of COI estimates across jurisdictions would contribute significantly to resolving the issue of transferability of cost-effectiveness results [ 45 ]. Transferability is a very important issue around the world and especially in Central or Eastern Europe with limited resources to provide COI studies [ 53 – 55 ]. Data transferability and transferability of the results are not discussed in these COI studies.…”

When health technology assessment is confidential and experts have no power: the case of Hungary

“…Health technology assessment (HTA) supports decision-makers in allocating scarce resources for expensive medical technologies, primarily pharmaceuticals (Henshall et al ., 1997; Banta, 2003; Valesco-Garrido and Busse, 2005). It offers particular opportunities in settings such as Central and Eastern European (CEE) countries (Mandrik et al ., 2015) that face significant budgetary constraints and where sub-optimal investment decisions bring substantial opportunity costs (Kolasa et al ., 2016). The potential benefits of HTA include more rational use of resources, improved patient outcomes resulting from greater use of evidence-based technologies (Zechmeister and Schumacher, 2012; Schumacher and Zechmeister, 2013) and, more generally, by contributing to a climate that values evidence in health care policy and practice (Oortwijn et al ., 2008).…”

Balanced assessment systems revisited

“… Transferability of assessment results . As is the case with the generalizability of clinical trial outcomes to broader populations, the transferability of assessment results between systems is a hot topic in HTA [ 13 , 14 ]. The logic of balanced assessment has also highlighted the contradiction between the pragmatic need for using external references (e.g., previous assessment reports or funding decisions) and the legitimate academic and methodological concerns regarding transferability of evidence.…”