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Health economic analyses in digestive diseases


Clinical bottom line

Only a minority of health economic studies in digestive diseases were of high quality.


Health economic analysis is important in determining the place of interventions in medicine and healthcare. Quality criteria for health economic analyses have been investigated, but many published analyses fail to meet the guidelines, and may mislead even if they do fit the guidelines.


BR Spiegel et al. The quality of published health economic analyses in digestive diseases: a systematic review and quantitative appraisal. Gastroenterology 2004 127: 403-411.

Systematic review

English-language health economic studies were sought in the area of digestive diseases between January 1980 January 2004. Journal with an impact factor above 1 were used to identify studies, using an electronic search strategy. The aim was to assess the studies for quality, and to assess factors predicting high quality.

Quality was assessed using the Quality of Health Economic Studies (QHES) instrument, which is a validated 16-item instrument designed to measure the quality of health economic studies. Scores can range from 0 to 100, with yes/no answers to 16 separate questions each with values of 0 for absence to between 1 and 9 points for presence of each quality. High quality is 75-100 points, and fair quality is 50-75 points. Below 50 points studies are scored poor or very poor (below 25).


Of the 186 health economic studies found, 29% were scored as high quality and 52% as fair quality (Figure 1). Quality scores were higher in more recently published papers (Figure 2). The following questions had positive scores infrequently:

Figure 1: QHES scoring of 186 health economic studies in digestive diseases

Figure 2: Mean QHES scores over years 1990 to 2004

The review also sought factors predicting high quality, and concluded that these were authors having advanced training in health services, study using decision-analysis software package (against not using one), study receiving federal funding, and study citing guidelines for health economic studies in the reference list.


This is interesting work, showing how few health economic studies are of highest quality. Bandolier has a slight concern over the finding about the relationship between study quality and advanced training in health services, as not all journals give degrees, and when this did not occur it was inferred by assuming that coming from a department of, for instance, public health, or epidemiology, for instance, was equivalent. This seems a little cavalier, but we know what they mean.