The Generalisabilityof Economic Evaluation

抄録

Objective : A major challenge to the usefulness of economic evaluation for decision-making is concern over the generalisability of the results. The purpose of this paper is to review the methodological issue of generalisability within economic evaluation and to discuss approaches for facilitating the generalisability of economic analysis to the Japanese context.
Methods : Electronic searches of key databases (MEDLINE, HEALTHSTAR, OHE, NHS EED) and handsearches of key health economics and health technology journals (ISTAHC, Pharmacoeconomics, Health Economics) in the period 1990-2000 were conducted to identify papers relating to factors affecting and methods for enhancing generalisability across three dimensions : (i) from study to practice, (ii) between location and (iii) across time. These papers were critically reviewed and the information combined into a structured commentary.
Results : Several factors can potentially limit the generalisability of results including differences in epidemiology, the availability of treatments, clinical practice patterns, relative prices and incentives to healthcare professionals and institutions. Several analytical approaches are in existence, which allow the generalisation of health economic data to any local decision-making context. These include statistical analysis of data from multinational clinical-economic trials, the use of economic modelling and the systematic review of economic data.
Conclusion : Further research in the area of generalisability will add to the credibility and usefulness of economic evaluations in general and give decision-makers confidence that the data are suitable for use as a basis for resource-allocation decisions and provide some comfort that the actions arising from their use are not misguided.