Systematic reviews of economic evaluations: utility or futility?
Abstract
Systematic reviews of studies of effectiveness are the centrepiece of evidence‐based medicine and policy making. Increasingly, systematic reviews of economic evaluations are also an expected input into much evidence‐based policy making, with some health economists even calling for ‘an economics approach to systematic review’. This paper questions the value of conducting systematic reviews of economic evaluations to inform decision making in health care. It argues that the value of systematic reviews of economic evaluations is usually undermined by three things. Firstly, compared with effectiveness studies, there is a much wider range of factors that limit the generalisability of cost–effectiveness results, over time and between health systems and service settings, including the context‐dependency of resource use and opportunity costs, and different decision contexts and budget constraints. Secondly, because economic evaluations are more explicitly intended to be decision‐informing, the requirements for generalisability take primacy, and considerations of internal validity become more secondary. Thirdly, since one of the two main forms of economic evaluation – decision analytic modelling – is itself a well‐developed method of evidence synthesis, in most cases the need for a comprehensive systematic review of previous economic evaluations of a particular health technology or policy choice is unwarranted. I conclude that apparent ‘meta‐analytic expectations’ for clear and widely applicable cost–effectiveness conclusions from systematic reviews of economic evaluations are optimistic and generally futile. For more useful insights and knowledge from previous economic studies in evidence‐based policy making, a more limited range of reasons for conducting systematic reviews of health economic studies is proposed. Copyright © 2009 John Wiley & Sons, Ltd.
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In health economics, systematic literature reviews on the relative cost-effectiveness of different interventions are increasingly used in health care system decision-making.
“In the health economics field, SLRs on the relative cost-effectiveness of different interventions are increasingly used in health care system decision-making (Anderson, 2010; Jacobsen et al., 2020; Luhnen et al., 2018; Mandrik et al., 2021).”
From Analysis of article screening and data extraction performance by an AI systematic literature review platform (2025) · cites this paper as Anderson, 2010
A cost-effectiveness analysis was chosen for this case study as SLRs of this kind involve unique challenges, including heterogeneity in study design, interventions, populations, and settings.
“A cost-effectiveness analysis was chosen for this case study as SLRs of this kind involve unique challenges, including heterogeneity in study design, interventions, populations, and settings (Anderson, 2010; Husereau et al., 2022; Jacobsen et al., 2020; Mandrik et al., 2021).”
From Analysis of article screening and data extraction performance by an AI systematic literature review platform (2025) · cites this paper as Anderson, 2010
Economic evaluations are one of many important factors in decision-making about EBP use.
“Research from varied global contexts consistently shows that economic evaluations are one of many important factors in decision-making about EBP use [16–18].”
From Translating economic evaluations into financing strategies for implementing evidence-based practices (2021) · cites this paper as [16]
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“In the health economics field, SLRs on the relative cost-effectiveness of different interventions are increasingly used in health care system decision-making (Anderson, 2010; Jacobsen et al., 2020; Luhnen et al., 2018; Mandrik et al., 2021).”
- Authors
- Anderson, R.
- Affiliations
- University of Exeter (GB)
- Corresponding author
- Anderson, Rob
- ORCID
- Anderson, Rob
- Venue
- Health Economics
- Publisher
- Wiley
- Published
- 2010-02-08
- Volume
- 19
- Issue
- 3
- Pages
- 350-364
- ISSN
- 1057-9230 (ISSN-L)
- 1099-1050
- OpenAlex
- W2090385390
- Cited by
- 173
- References
- 50
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 4 · 2023: 8 · 2022: 16 · 2021: 11 · 2020: 18 · 2019: 16 · 2018: 12 · 2017: 10 · 2016: 12 · 2015: 7 · 2014: 10 · 2013: 13 · 2012: 12
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Economics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Keywords
- cost-effectiveness, opportunity cost, internal validity, decision-analytic modeling, evidence synthesis, healthcare decision-making, evidence-based policy making, health technology appraisal
- MeSH terms
- Cost-Benefit Analysis, Costs and Cost Analysis, Evaluation Studies as Topic, Humans, Review Literature as Topic, Evidence-Based Medicine
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