title: Comparison of Economic Evaluation Methods Across Low-income, Middle-income and High-income Countries: What are the Differences and Why?
abstract: There are marked differences in methods used for undertaking economic evaluations across low-income, middle-income, and high-income countries. We outline the most apparent dissimilarities and reflect on their underlying reasons. We randomly sampled 50 studies from each of three country income groups from a comprehensive database of 2844 economic evaluations published between January 2012 and May 2014. Data were extracted on ten methodological areas: (i) availability of guidelines; (ii) research questions; (iii) perspective; (iv) cost data collection methods; (v) cost data analysis; (vi) outcome measures; (vii) modelling techniques; (viii) cost-effectiveness thresholds; (ix) uncertainty analysis; and (x) applicability. Comparisons were made across income groups and odds ratios calculated. Contextual heterogeneity rightly drives some of the differences identified. Other differences appear less warranted and may be attributed to variation in government health sector capacity, in health economics research capacity and in expectations of funders, journals and peer reviewers. By highlighting these differences, we seek to start a debate about the underlying reasons why they have occurred and to what extent the differences are conducive for methodological advancements. We suggest a number of specific areas in which researchers working in countries of differing environments could learn from one another.
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Ulla Kou
authors.initials: UK
authors.lastname: Griffiths
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Rosa
authors.initials: R
authors.lastname: Legood
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pitt
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods*; D003430:Cross-Sectional Studies; D019049:Developed Countries / Q000191:economics*; D003906:Developing Countries / Q000191:economics*; D004470:Economics, Medical; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D018803:Models, Economic; D012107:Research Design
keywords: cost-benefit; cost-effectiveness; low-income and middle-income countries; research methods; review