title: Investigating the Generalizability of Economic Evaluations Conducted in Italy: A Critical Review.
abstract: OBJECTIVE
  To assess the methodological quality of Italian health economic evaluations and their generalizability or transferability to different settings.
  
  
  METHODS
  A literature search was performed on the PubMed search engine to identify trial-based, nonexperimental prospective studies or model-based full economic evaluations carried out in Italy from 1995 to 2013. The studies were randomly assigned to four reviewers who applied a detailed checklist to assess the generalizability and quality of reporting. The review process followed a three-step blinded procedure. The reviewers who carried out the data extraction were blind as to the name of the author(s) of each study. Second, after the first review, articles were reassigned through a second blind randomization to a second reviewer. Finally, any disagreement between the first two reviewers was solved by a senior researcher.
  
  
  RESULTS
  One hundred fifty-one economic evaluations eventually met the inclusion criteria. Over time, we observed an increasing transparency in methods and a greater generalizability of results, along with a wider and more representative sample in trials and a larger adoption of transition-Markov models. However, often context-specific economic evaluations are carried out and not enough effort is made to ensure the transferability of their results to other contexts. In recent studies, cost-effectiveness analyses and the use of incremental cost-effectiveness ratio were preferred.
  
  
  CONCLUSIONS
  Despite a quite positive temporal trend, generalizability of results still appears as an unsolved question, even if some indication of improvement within Italian studies has been observed.
authors: Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy.
authors: Matteo
authors: M
authors: Ruggeri
authors: Centre for Health Economics, University of York, York, UK.
authors: Andrea
authors: A
authors: Manca
authors: Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: silvia.coretti@rm.unicatt.it.
authors: Silvia
authors: S
authors: Coretti
authors: Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy.
authors: Paola
authors: P
authors: Codella
authors: Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy.
authors: Valentina
authors: V
authors: Iacopino
authors: Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy.
authors: Federica
authors: F
authors: Romano
authors: Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy.
authors: Daniele
authors: D
authors: Mascia
authors: Inter-departmental Research Centre of PharmacoEconomics and Drug utilization (CIRFF), Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy.
authors: Valentina
authors: V
authors: Orlando
authors: Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy.
authors: Americo
authors: A
authors: Cicchetti
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D007558:Italy; D008390:Markov Chains; D018803:Models, Economic; D013673:Technology Assessment, Biomedical / Q000191:economics*
keywords: economic evaluation; model-based economic evaluation; review; trial-based economic evaluation