Economic Evaluation Methods in Post-Injury Care: A Global Systematic Review and Critical Appraisal of Their Suitability for Decision-Making

Over 4 million people (8% of all deaths) worldwide die from traumatic injuries annually. For people aged 5–29 years, three of the top five causes of death are injury related, namely road traffic injuries, homicide, and suicide. Investments in injury care need to consider budget constraints, and economic evaluation studies can be employed to understand the costs and outcomes of competing interventions for injury care. However, these studies should be designed to meet the information requirements of decision makers. This systematic review aims to critically appraise the methodologies used in economic evaluations of injury care, assessing their suitability for informing decision-making. We conducted a global systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched six databases, from inception to June 2023, for eligible full economic evaluations of injury care. The primary population was persons who have suffered acute traumatic injuries. Only full economic evaluations were eligible for inclusion, and studies that met the inclusion criteria were appraised using the Consolidated Health Economic Evaluation Reporting Standards statement and critiqued against the decision-making guidelines developed by Sculpher et al. (2009). A total of 259 studies were included in the final review. An overwhelming majority of the studies (92%) were conducted in high-income countries, and they predominantly evaluated in-hospital interventions (93% vs 1% pre-hospital and 6% post-discharge). Fractures were the most commonly studied injury type, while the provider perspective was the most frequent analytic perspective. We found that just over half of the studies synthesised effectiveness evidence from multiple sources; nearly a quarter of the studies compared more than two competing interventions; and 84% of the studies considered costs and outcomes over an appropriate time horizon. We found key gaps in the existing evidence: limited synthesis of evidence to inform treatment effects, inadequate alignment of time horizons with intervention outcomes, geographic disparities in the scope and quality of evidence, and limited coverage across the full patient pathway. These limitations hinder the usefulness of study findings in decision-making. Future economic evaluations should address key gaps to improve the utility of economic evaluations in healthcare decision-making. PROSPERO: CRD42022351978.