State of Evidence on Cost-Effectiveness Analysis of Health Technologies in Colombia: A Systematic Literature Review

OBJECTIVES: To characterize the published evidence on the cost-effectiveness analysis (CEA) of health technologies in Colombia.

METHODS: Per the PRISMA statement we searched for CEA and cost utility analysis (CUA) for any health technology published in PubMed-Medline and Scielo databases, without time restriction, until June 22, 2023. Titles and abstracts were screened using classifications suggested by artificial intelligence in Rayyan. Six groups were generated to classify the CEA/CUAs performed in Colombia: medical supplies, drugs, medical procedures, medical care programs, diagnostic tests, and vaccines. We only considered complete economic evaluations. We extracted and considered for the analysis data on year of publication, perspective, discount rate, type of decision modelling, type of technology assessed, and outcome. Absolute and relative frequencies were used to describe the main features of the CEA/CUAs.

RESULTS: Overall, 482 were retrieved; we included 187 full texts. First CEA/CUA publication was in 1987 and 71.1% (n=133) were published after 2014. 75.9% (n=142) of CEA/CUAs were performed from the third payer perspective, and 18.2% from society perspective. 51.8% (n=97) used discount rates from 3-5%; 47.1% (n=88) did not use discount rate because had <1year time horizon. Markov and tree decision models were used in 80 (42.8%) and 67 (35.8%) studies, respectively; 5.3% of the studies performed microsimulations models (all published after 2011). QALYs were used as outcomes in 92 studies (48.7%), DALYs in 23 (12.2%), and intermediary outcomes in the rest. 85 (45.5%) CEA/CUAs were developed for drugs, 26 (13.9%) for vaccines, 23 (12.3%) for diagnostic tests, 22 (11.8%) for medical care programs, 17 (9.1%) for medical procedures, and 14 (7.5%) for medical supplies.

CONCLUSIONS: This systematic review showed variability in modelling methods, outcomes, and therapeutic areas for CEA/CUAs in Colombia. Further analysis should assess the quality of the published evidence on CEA/CUAs.