Quality of economic evaluations in health care

Economic evaluation is becoming established globally as one of the tools for decision making in health care.1 Its rise in popularity is reflected by the increasing number of published economic evaluations. One source estimates that 1803 economic evaluations were published in medical journals in 1979-90,2 rising to 2222 in 1991-6.3 This increase in both the availability of economic evaluations and willingness to use their results to allocate scarce resources reinforces the need for evaluations to be methodologically sound so that the consequent healthcare decisions are ethically defensible. Do our current economic evaluations meet the necessary methodological requirements? In the early 1990s several systematic reviews cast doubt on the scientific reliability of some published evaluations. All advocated better standards of conducting and reporting economic evaluations.4–7 A subsequent survey among editors of medical journals found that none had a coherent editorial policy for economic evaluations, and few had peer reviewers with knowledge …