The use of economic evaluations in health decision-making at the macro level: a literature review

Abstract

Objectives: The number of health economic evaluations (EE) increases but their role in decision-making remains unclear. This literature review aims to describe methods used to investigate the use of EE by decision-makers at the macro level; and to analyse the impact of economic evaluations on decision making between developed and developing countries. Methods: Five major databases were searched in seven languages, without time limit, using keywords related to economics, research methods, decision-making and outcomes. Titles and abstracts were screened according to four criteria. Twenty-nine articles were selected, analysed and compared against a checklist for context, methods and outcomes. Results: Most articles reported single-country studies (n=24) conducted in developed countries (n=20). The target population investigated was mainly composed by health authorities. The following methods were used: questionnaires (n=12), qualitative approaches (n=6), documentary analysis (n =4). Methods triangulation was observed in 6 studies. The use of EE has increased since the late 1990s, though there are differences between countries. EE is mainly encouraged by governmental/institutional incentives. Barriers preventing its wider use are similar among developed and developing countries and mostly related to the accessibility and acceptability of EE. Conclusions: The use of economic evaluations in health-policy decision-making can be enhanced by reducing simple obstacles, e.g. improving the quality of studies through the elaboration of guidelines.