Economic Evaluations in Kidney Transplantation: Frequency, Characteristics, and Quality-A Systematic Review

Background. Economic evaluation provides a unique tool for informing healthcare decisions by explicitly quantifying limited resources required to achieve health gains and are widely used by policy makers to inform regulatory and subsidy decisions, but the validity of these studies in the field of transplantation is unknown. Aim. The objective of this study is to describe and evaluate the quality and reporting of recently published economic evaluations in kidney transplantation. Methods. A comprehensive literature search was undertaken for economic evaluations of interventions used in kidney transplantation published between January 2000 and December 2011. Results. A total of 66 studies were identified, with the majority (>60%) being supported by academia. About 80% of the included studies reported highly favorable cost-effectiveness ratios, with the majority showing dominance against the comparator. The overall qualities of the studies were adequate, but there was no improvement in the overall quality and frequency of economic evaluations over time. On a continuous scale between 0 and 1, studies that used a broader (societal) perspective, assessed health gains in quality adjusted life years, were supported by academia, and evaluated non-pharmaceutical interventions were associated with a 5% to 10% increase in the overall quality of the studies compared to studies that employed a narrower perspective, assessed health gains in natural units, were supported by industry, and evaluated pharmaceutical interventions. Conclusions. Economic evaluations are infrequently published in transplantation, but the overall methodological quality is high. Publication bias appears highly prevalent, with under-representation of studies that find small health gains and less favorable cost-effectiveness ratios published.