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Economic evaluations in undergraduate medical education: a systematic review
Stijntje Willemijn Dijk1,2,3, Skander Essafi4, Christa Niehot5
1Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Zuid-Holland, Netherlands.
Objectives:
Medical education profoundly impacts patients, students, educators and public resources. However, the economic dimensions necessary for informed decision-making remain underexplored. This systematic review examines how economic evaluations are conducted and reported in undergraduate medical education (UME) literature and assesses their quality.
Design:
Systematic review.
Data Sources:
Medline, Embase, Web of Science, Cochrane, ERIC, Google Scholar and the CEVR CEA databases were searched on 13 September 2024.
Eligibility Criteria:
Eligible studies evaluated interventions within UME and reported (incremental) costs and effects, employing any method such as cost-effectiveness analysis, cost-minimisation analysis or decision-analytic modelling.
Data Extraction And Synthesis:
Key data, including study characteristics, evaluation type, perspective, intervention details, sensitivity analyses, cost and effect measures, outcomes, expressions of cost-effectiveness and adherence to economic reporting guidelines, were extracted. Quality was assessed using the CHEQUE tool, and the findings were synthesised qualitatively.
Results:
Of 6559 studies identified, 21 met the inclusion criteria. Most studies reported costs and effects post-hoc within effectiveness trials, with only one decision-analytic modelling study identified. Evaluated domains included instructional methods, skills training, selection and student health. All but one study adopted a payer (university) perspective, and nearly all focused on short-term outcomes. Sensitivity analyses were rarely performed, and no study achieved full quality scores.
Conclusions:
Economic evaluations in UME are scarce and often of limited methodological rigour. A shift towards comprehensive, prospective evaluations is needed to address long-term outcomes, societal perspectives and methodological robustness. Such efforts will enable better resource allocation, enhance the impact of medical education and contribute to a sustainable educational landscape.
Prospero Registration Number:
CRD42023478907.
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