Economic analyses in obstetrics and gynecology: a methodologic evaluation of the literature

To evaluate the methodology of the cost-effectiveness and cost-benefit literature in obstetrics and gynecology.

We performed a MEDLINE search of the general and subspecialty obstetrics and gynecology journals for the years 1990 through 1996.

Original investigations including cost-effectiveness or cost-benefit were evaluated by two reviewers for adherence to ten minimum methodologic standards derived by a review of guidelines for medical economic analyses. The major criteria considered included: 1) provision of comparative options, 2) statement of analytic perspective, 3) presentation of cost data, 4) identification of outcome measure, 5) use of summary measure of economic effectiveness or benefit, and 6) performance of a sensitivity analysis. The minor criteria evaluated included: 1) statement of source of cost data, 2) inclusion of long-term costs, 3) use of discounting, and 4) calculation of an incremental summary measure.

Ninety-eight articles that included cost-benefit or cost-effectiveness analyses were identified. The mean number of major and minor principles adhered to were 3.6 and 1.0, respectively. Five publications (5.1%) conformed to all ten major and minor criteria, whereas nine (9.2%) articles used all six major criteria. The provision of cost data (94.8%) and statement of comparative options (96.9%) were the major principles most frequently adhered to, whereas the use of discounting (10.2%) and statement of analytic perspective (19.3%) showed the lowest compliance. Agreement between the reviewers was excellent (kappa .87).

Published economic analyses in the obstetrics and gynecology literature seldom adhere to all recommended methodologic guidelines. Further training in the methodology of cost-effectiveness analysis is needed within the specialty.