Interpretation of the results of a review of health economics studies is dependent on the specific economic questions and context of relevance to a given decision regarding the provision of health care. In Cochrane reviews – intended for an international audience – there are clearly a large number of potential economic questions and contextual factors that different decision-making constituencies may need to take into account. Given this global context, it is simply not feasible to interpret the results of a critical review of multiple economic evaluation studies in order to draw conclusions about the adoption or rejection of a healthcare treatment or diagnostic test, for example. However, whilst in these circumstances the Cochrane review is unlikely to provide the central aspect of any policy evaluation, it can still help to refine an economic discussion and to set this in an international context (Gilbody 1999).
In a review topic area with few or no relevant, high-quality economic evaluation studies, the critical review of health economics studies can serve to highlight a lack of economics evidence that future research may need to address. The need for further economic evaluation studies should be stated within the ‘Implications for research’ part of the ‘Authors' conclusions’ section of the review. Box 15.8.a shows two examples of this type of statement. It should also be considered that since a full economic evaluation is predicated on the availability of reliable data on intervention effectiveness, a lack of robust effectiveness studies would clearly impact upon the feasibility and availability of full economic evaluation studies. Again, whilst Cochrane and other systematic reviews cannot overcome this limitation, they can draw attention to it within their conclusions sections.