Systematic reviews are central to evidence-based policy and practice. In health economics, they help compare costs and outcomes across interventions, offering valuable insights for decision-makers. Yet, reviewing economic evidence brings unique challenges that differ from those in clinical effectiveness reviews. This post highlights two common challenges and best practices for conducting systematic reviews of economic evaluations in health and social care research.

Challenge 1: Limited generalisability 

Economic evaluations are highly context-dependent. Unlike clinical studies, their findings are strongly influenced by differences in healthcare systems, costs, prices, and resource use across countries or regions. A cost-effectiveness result from one setting may not apply elsewhere because resource inputs, treatment pathways, or budget constraints differ. For example, an intervention found cost-effective in one national health system may not be affordable in another with lower healthcare spending or different priorities.

Because of this, many systematic reviews of economic evaluations struggle to draw general conclusions. Transferability — how relevant results are to a specific decision context — often becomes more important than traditional measures of study quality. In some cases, a full systematic review may even be unnecessary if studies come from very different contexts. Still, such reviews remain useful to map the evidence base and highlight methodological progress within a field.

Further readings:

1. Systematic reviews of economic evaluations: utility or futility? Anderson 2010
2. Generalisability in economic evaluation studies in healthcare: a review and case studies  Sculpher 2004

Challenge 2: High eterogeneity in methods and results

Economic evaluations differ widely in scope, design, and assumptions. Some are trial-based; others rely on decision-analytic models. They vary in time horizon, perspective (societal or payer), discount rate, and outcome measure (e.g., QALYs, DALYs, or cost per life saved).

This heterogeneity makes quantitative synthesis — like meta-analysis — rarely feasible. Combining cost-effectiveness ratios across studies is problematic because costs, currencies, and model structures are not comparable.

As a result, most systematic reviews of economic evidence rely on narrative synthesis rather than pooled analysis, describing similarities and differences rather than producing a single summary estimate.

Further readings:

1. How to prepare a systematic review of economic evaluations for informing evidence‑based healthcare decisions van Mastrigt GAPG 2016
2. Critical appraisal of systematic reviews with costs and cost‑effectiveness outcomes: An ISPOR good practices task force report Mandrik 2021

Best Practice 1: Define context and transferability early

Before starting a review, it’s essential to define which context and decision-maker the review aims to inform. Key questions include:

• Which countries or healthcare systems are relevant?
• What cost structures and price levels apply?
• How will differences in practice affect applicability?

Being explicit about context improves the usefulness of the review and helps readers interpret findings appropriately. The Cochrane guidance on economic evidence recommends assessing transferability and separating trial-based from model-based analyses for this reason.

Further readings:

1. What do international pharmacoeconomic guidelines say about economic data transferability? Barbieri 2010
2. Matching Methods for Causal Inference: A Review and a Look Forward Stuart 2010

Best Practice 2: Use structured methods and transparent reporting

Even when synthesis is qualitative, systematic reviews can still be rigorous. Using structured tools — such as the CHEERS reporting standards and the Drummond checklist — helps assess study quality and transparency. Clear extraction of variables (population, perspective, costs, outcomes) and transparent reporting of heterogeneity strengthen the credibility of findings. When statistical synthesis isn’t possible, a structured narrative approach ensures clarity and reproducibility.

Further readings:

1. CHEERS Reporting Guidelines for Economic Evaluations Fayanju 2021
2. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Statement: Updated Reporting Guidance Husereau 2022

Conclusion

Systematic reviews of economic evidence are vital but complex. Their greatest challenges — limited generalisability and methodological heterogeneity — can be managed with careful planning, structured appraisal, and transparent reporting. By focusing on context and rigour, researchers can turn diverse economic studies into meaningful insights for health and social care policy.

Further readings:

1. Health economic evaluations of interventions for supporting adult carers in the UK: a systematic review from the NICE Guideline Pelone 2022
2. Assessing transferability in systematic reviews of health economic evaluations: a systematic review of methodological guidance Weise 2022
3. An overview of the characteristics and quality assessment criteria in systematic review of pharmacoeconomics Min 2021