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J Reprod Med. 2002 Aug;47(8):631-9.

Cost-effectiveness analyses in obstetrics & gynecology. Evaluation of methodologic quality and trends.

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Departments of Obstetrics, Gynecology and Reproductive Sciences and of Epidemiology and Biostatistics, University of California, San Francisco, USA.



To evaluate methodologic quality and trends of cost-effectiveness analyses (CEAs) published in Obstetrics & Gynecology.


Ten methodologic principles that should be incorporated in CEAs are used to evaluate CEAs published in Obstetrics & Gynecology from 1966 through 1999. We included articles that were cost-effectiveness or cost-benefit analyses or performed such analyses as part of their studies.


Thirty-four CEAs met our inclusion criteria. Seven (20%) analyses adhered to 10, five (15%) to 9, and two (6%) to 8 of the 10 methodologic principles. The mean (+/- SD, median) number of principles to which studies adhered was 5.7 (+/- 3.3, 4). Studies had high compliance (> or = 85%) with principles of research questions, probabilities and effectiveness measures. Studies significantly improved over time in adherence to principles of time frame, perspective, costs, incremental analysis, sensitivity analysis, discounting and total score (all P < .05).


The CEAs evaluated adhered to approximately half the methodologic principles for performing CEAs but showed significant improvements in quality over time. Understanding the methodology of CEAs is critical for researchers, editors and readers to accurately interpret the results of the growing body of CEA studies.

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