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Quality Assessment of Economic Analyses In Pediatric Urology

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Paul J. Kokorowski, MD, MPH1, Jonathan C. Routh, M.D., M.P.H.2 and Caleb P. Nelson, M.D., M.P.H.1, (1)Department of Urology, Children's Hospital Boston, Boston, MA, (2)Division of Urology, Duke University Medical Center, Durham, NC

Purpose: Economic evaluations, such as cost-effectiveness analysis, are increasingly common in the medical literature.  Our objective was to describe and evaluate economic analyses in the pediatric urologic lite rature.

Methods: We performed a systematic literature review of the MEDLINE, EMBASE, and Cochrane databases (1990-2011) to identify economic analyses of pediatric urologic topics. Studies were evaluated using published quality metrics. We examined the analysis type, data sources, perspective, methodology, sensitivity analyses, and the reporting of methods, results, limitations, and conclusions.

Results: We identified 2,945 non-duplicated studies, 60 of which met our inclusion criteria. Economic analyses of pediatric urologic topics increased in number during the study period, from 1 study (2%) in 1990 to 7 (12%) in 2010 (p<0.0001 for trend).  The most common types of analyses were cost-effectiveness and cost-minimization (22 each, 37%), typically performed from the payer perspective (26, 43%).  Although 44 (73%) correctly identified the analysis type, only 21 (35%) correctly identified the study perspective.  Optimal data sources were used in 7 studies (11%).  Appropriate inflationary discounting was used in 32% (17/53).  Sensitivity analyses were not reported in 58% (31/53).  The descriptions of study methods were adequate in 43 (72%); assumptions were adequately reported in 42 studies (70%).  Most (37, 62%) adequately discussed their limitations.  

Conclusion: Although economic analyses are increasing in the pediatric urologic literature, there is a need for standardization in methods and reporting. Future investigations should attempt to follow standardized reporting guidelines and should pay particular attention to reporting of methods and results, including a comprehensive discussion of limitations.