title: Evaluation of Health Economics in Radiation Oncology: A Systematic Review.
abstract: OBJECTIVE
  Despite the rising costs in radiation oncology, the impact of health economics research on radiation therapy practice analysis patterns is unclear. We performed a systematic review of cost-effectiveness analyses (CEAs) and cost-utility analyses (CUAs) to identify trends in reporting quality in the radiation oncology literature over time.
  
  
  METHODS
  A systematic review of radiation oncology economic evaluations up to 2014 was performed, using MEDLINE and EMBASE databases. The Consolidated Health Economic Evaluation Reporting Standards guideline informed data abstraction variables including study demographics, economic parameters, and methodological details. Tufts Medical Center CEA registry quality scores provided a basis for qualitative assessment of included studies. Studies were stratified by 3 time periods (1995-2004, 2005-2009, and 2010-2014). The Cochran-Armitage trend test and linear trend test were used to identify trends over time.
  
  
  RESULTS
  In total, 102 articles were selected for final review. Most studies were in the context of a model (61%) or clinical trial (28%). Many studies lacked a conflict of interest (COI) statement (67%), a sponsorship statement (48%), a reported study time horizon (35%), and the use of discounting (29%). There was a significant increase over time in the reporting of a COI statement (P<.001), health care payer perspective (P=.019), sensitivity analyses using multivariate (P=.043) or probabilistic methods (P=.011), incremental cost-effectiveness threshold (P<.001), secondary source utility weights (P=.010), and cost effectiveness acceptability curves (P=.049). There was a trend toward improvement in Tuft scores over time (P=.065).
  
  
  CONCLUSIONS
  Recent reports demonstrate improved reporting rates in economic evaluations; however, there remains significant room for improvement as reporting rates are still suboptimal. As fiscal pressures rise, we will rely on economic assessments to guide our practice decisions and policies. We recommend improved adherence to published guidelines and further research to determine the clinical implications of our findings.
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Nguyen
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada.
authors.forename: Chris D
authors.initials: CD
authors.lastname: Goodman
authors.affiliation: London Health Sciences Centre, London, Ontario, Canada.
authors.forename: R Gabriel
authors.initials: RG
authors.lastname: Boldt
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Warner
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Palma
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
authors.forename: George B
authors.initials: GB
authors.lastname: Rodrigues
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Lock
authors.affiliation: Department of Radiation Oncology, University of Maryland, Baltimore, Maryland.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Mishra
authors.affiliation: Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Ivey Business School, Western University, London, Ontario, Canada.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Zaric
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. Electronic address: Dr.alexlouie@gmail.com.
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Louie
mesh_terms: D057189:Checklist; D016265:Conflict of Interest; D003362:Cost-Benefit Analysis / Q000592:standards* / Q000639:trends; D016208:Databases, Factual / Q000706:statistics & numerical data; D017408:Guidelines as Topic; D005102:Health Expenditures / Q000592:standards* / Q000639:trends; D016239:MEDLINE / Q000706:statistics & numerical data; D009369:Neoplasms / Q000532:radiotherapy; D018787:Radiation Oncology / Q000191:economics*; D011878:Radiotherapy / Q000191:economics / Q000379:methods / Q000639:trends; D012109:Research Support as Topic / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States