Summarising economic evaluations in systematic reviews: a new approach

Systematic reviews of healthcare interventions, which are aimed at informing health policy, increasingly include economic evaluations in addition to evaluations of clinical effectiveness.1-3 The challenge reviewers face is collating, appraising, and synthesising economic evidence in such a way that it is clearly helpful in making decisions about the effects and costs of competing alternatives. However, the methodology for summarising the findings of economic evaluations is not as well established as that applied to structured summaries of clinical evidence. The aim of this paper is to illustrate and discuss the relative merits of commonly used methods and to offer a new approach that makes interpreting the evidence easier for decision makers who require a clear overview of the findings.

Summary points

Systematic reviews of healthcare interventions are increasingly integrating clinical and economic evidence

Methods are needed to summarise and convey clearly the findings of these reviews

The methodology for summarising the results of economic evaluations is not well established

Methods for summarising the results of economic evaluations include narratives, tables, the cost effectiveness plane, and permutation matrices

A new hierarchical method offers an effective means of summarising the results of economic evaluations within a systematic review

We describe well established methods that can be used to summarise the findings of a review of economic evaluations, namely narrative summaries, permutation matrices, and the cost effectiveness plane, and we give examples of how a permutation matrix has or could have been used in two published systematic reviews. Finally, a new method is described that presents the same information in a clear, concise, and hierarchical manner and which provides an effective tool for summarising the same results.