Smith W J, Blackmore C C
Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, USA.
Obstet Gynecol. 1998 Mar;91(3):472-8. doi: 10.1016/s0029-7844(97)00679-0.
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.
TABULATION, INTEGRATION, AND RESULTS: 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.
评估妇产科领域成本效益和成本效益文献的方法学。
我们对1990年至1996年的妇产科综合及专科期刊进行了MEDLINE检索。
由两名评审员对包括成本效益或成本效益分析在内的原始研究进行评估，看其是否符合通过医学经济分析指南回顾得出的十条最低方法学标准。考虑的主要标准包括：1）提供比较选项；2）分析视角的陈述；3）成本数据的呈现；4）结果测量指标的确定；5）经济有效性或效益的汇总测量指标的使用；6）敏感性分析的执行。评估的次要标准包括：1）成本数据来源的陈述；2）长期成本的纳入；3）贴现的使用；4）增量汇总测量指标的计算。
制表、整合与结果：共识别出98篇包含成本效益或成本效益分析的文章。主要和次要原则的平均遵循数量分别为3.6条和1.0条。五篇出版物（5.1%）符合所有十条主要和次要标准，而九篇文章（9.2%）使用了所有六条主要标准。成本数据的提供（94.8%）和比较选项的陈述（96.9%）是最常遵循的主要原则，而贴现的使用（10.2%）和分析视角的陈述（19.3%）的符合率最低。评审员之间的一致性非常好（kappa值为0.87）。
妇产科文献中发表的经济分析很少遵循所有推荐的方法学指南。该专业领域需要进一步开展成本效益分析方法的培训。
