Economic evaluations in the critical care literature

OBJECTIVE: To determine the extent to which economic evaluations published in the critical care literature provide information that can help us to improve the efficiency of our unit. DATA SOURCES: We searched computerized bibliographic databases and manually searched key critical care journals to retrieve all economic evaluations. STUDY SELECTION: We included economic evaluations that dealt with clinical problems relevant to the practice of adult critical care and that compared competing healthcare interventions. DATA ABSTRACTION: Included articles were further evaluated using criteria for minimal methodologic soundness, adopted from the literature, and criteria that we developed to assess the generalizability of results to our clinical setting. DATA SYNTHESIS: We screened 4,167 papers manually and > 450 abstracts and titles in our computer search. One hundred fifty-one papers were retrieved for further evaluation; 29 papers met our inclusion criteria. Of these 29 papers, only 14 (48%) adequately described competing healthcare interventions, 17 (59%) provided sufficient evidence of clinical efficacy, six (21%) identified, measured, and valuated costs appropriately, and three (10%) performed a sensitivity analysis. None of the papers met all four of these criteria for a minimum level of methodologic soundness. Four (14%) of 29 studies which adequately dealt with issues of cost and efficacy were evaluated using our generalizability criteria. Different costing methods precluded the application of the results of three of the four studies to our intensive care unit. CONCLUSIONS: In the critical care literature, very little useful economic information exists to help decision-makers maximize efficiency in their own setting.