gms | German Medical Science

Background and status of (inter)national research: In times of scarce health resources, economic evidence plays an important role when making decisions about the reimbursement of health technologies. Health Technology Assessment (HTA) organisations use either primary economic evaluations (P-HE) or Systematic Reviews of health economic evaluations (SR-HE) to inform decision-making. The latter is a rather new approach that poses an important question: are the results from existing economic evaluations generalisable to specific decision contexts (e.g. jurisdictions)? This can principally be queried - especially due to the high variability of cost and resource needs across countries. Therefore, someone might doubt the usefulness of SR-HE in general. However, in contrast to a P-HE, a SR-HE can save effort and time.

Question and objective: Our objective was to review the methods documents of HTA organisations to determine how generalisability is recommended to be considered when performing a SR-HE.

Method: We systematically hand searched the webpages of 158 HTA organisations for potentially relevant methods documents from January to March 2019. We identified the HTA organisations through publicly available member lists of international HTA umbrella organisations. Two independent reviewers performed hand searches and selected documents according to pre-defined eligibility criteria. One reviewer extracted data in standardised and piloted tables and a second reviewer checked them for accuracy. We extracted and aggregated data according to the following issues: the types of considered health technologies, the underlying terminology (e.g. generalisability or transferability), the assessment approach concepts (e.g. assessment standardisation) and the recommended assessment criteria. We describe our findings in a structured narrative manner and visually present extracted data using tabulations. Additionally, we analyse similarities and differences between the recommendations.

Results: We identified 155 potentially relevant documents on the webpages of 63 HTA organisations. Of these, 7 fulfilled our eligibility criteria and were included in the synthesis. The included organisations have different aims when preparing a SR-HE (e.g. determine the need for conducting their own P-HE). The methodological recommendations vary regarding the underlying terminology, the assessment approaches (e.g. assessment standardisation), the content of assessments (e.g. assessment criteria) and the integration in the review process.

Discussion: Only few HTA organisations address the assessment of generalisability in their methodological recommendations for SR-HE. The assessment concepts and content of are heterogeneous. Generalisability considerations are related to the review purpose.

Practical implications: Our work provides a basis for developing or adapting current assessment approaches.

Appeal for practice (science and/or care) in one sentence: Developing standards to consider generalisability in SR-HE is desirable.