title: A systematic review of the use of economic evaluation in local decision-making.
abstract: OBJECTIVE
  In view of resource scarcity, decisions have to be made on the optimal allocation of resources and one possible option in health care is economic evaluation. Little is known, however, about the use of economic evaluation. The objectives of this review were to assimilate the empirical evidence on this topic, discuss the main findings, and explore the possible need for further work needed in this area.
  
  
  METHODS
  A total of 40 studies were included in the review from a range of countries. A systematic search strategy was used and data from papers were extracted in a systematic way.
  
  
  RESULTS
  Pharmacists and clinicians in the US are the most frequently sampled group and postal surveys was the most commonly used method. Despite some positive findings, in most cases there appear to be obstacles to the extensive use of economic evaluation in decision-making. Obstacles can be linked to three factors: (1) institutional and political; (2) cultural; (3) methodological factors associated with economic evaluation itself.
  
  
  CONCLUSIONS
  There has clearly been an increase in the use of economic evaluation over time, especially in the UK, whereas the US appears to have a deep rooted disfavour of the approach. However, there is still little known about the exact influence of economic evaluation at the local level. Whilst work conducted to date has been valuable in providing information about use and barriers to use, further qualitative work is needed to enrich and explain some of the findings from this review.
authors.affiliation: National Perinatal Epidemiology Unit, University of Oxford, Old Road, Headington, Oxford OX3 7LF, UK. Oya.Eddama@npeu.ox.ac.uk
authors.forename: Oya
authors.initials: O
authors.lastname: Eddama
authors.forename: Joanna
authors.initials: J
authors.lastname: Coast
mesh_terms: D003657:Decision Making; D015276:Health Care Rationing / Q000191:economics / Q000592:standards; D009111:Local Government; D017059:Models, Econometric