Abstract Purpose/objective Health economic evaluations (HEE) are increasingly having an impact on policymakers, although the results greatly depend on the quality of the methodology used and on transparent reporting. The two main objectives of this study were to evaluate the quality of cost analyses of external beam radiotherapy (EBRT) and to assess the comprehensiveness and relevance of cost criteria defined in three validated quality-assessment instruments. Materials and methods The selection of articles was based on a previous systematic literature review of EBRT-costing studies retrieved from January 2004 to January 2015 (Period 1) in MEDLINE, Embase, and NHS-EED databases and completed in a second time period from January 2015 to November 2018 (Period 2). Three validated instruments to assess the methodology quality with the CHEC and the QHES, and the methodology with the CHEERS checklists were used. The quality was evaluated by both quantitative and qualitative analyses. The scoring robustness was examined with the Kendall coefficient of concordance and inter-class correlation coefficients. Results In total, twenty-three articles were selected. The main geographic areas of cost analyses were Canada (n = 5), France (n = 4), and the USA (n = 4). The most commonly studied pathologies and technologies were prostate (n = 7) and head and neck cancer (n = 5) and IMRT (n = 8) and IGRT (n = 2), respectively. The mean instrument scores demonstrated a fair degree of methodological quality, with 69.7% for the CHEC, 73.6% for the QHES, as well as for the reporting quality, with 59.4% for CHEERS for Period 1 (74.4%, 71.5%, and 66.1%, respectively, for Period 2). An additional qualitative analysis per criterion revealed that certain items, essential for understanding the costing methodology and the results (e.g., the time horizon, discount rate, sensitivity analysis) were often only partially completed. Statistical analysis confirmed that the reviewers’ scoring was consistent. The instruments identified the same top three articles, albeit with a degree of variation in the ranking. Conclusion Qualitative and quantitative assessment of cost analyses in EBRT exhibits a fair level of study quality in terms of the methodology and reporting transparency. The impact of cost calculations on the final HEE result appears to be underestimated, and increased transparency of the data sources and the methodologies is needed.

中文翻译：

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放射治疗成本分析的严格审查和质量评估：数据的可靠性如何？

摘要 目的/目标 卫生经济评估 (HEE) 对决策者的影响越来越大，尽管结果在很大程度上取决于所用方法的质量和透明的报告。本研究的两个主要目标是评估外照射放疗 (EBRT) 成本分析的质量，并评估三个经过验证的质量评估工具中定义的成本标准的全面性和相关性。材料和方法 文章的选择基于先前对 2004 年 1 月至 2015 年 1 月（第 1 期）在 MEDLINE、Embase 和 NHS-EED 数据库中检索的 EBRT 成本计算研究的系统文献综述，并在 1 月的第二个时间段内完成2015 年至 2018 年 11 月（第 2 期）。三个经过验证的工具，用于评估 CHEC 和 QHES 的方法学质量，并使用了 CHEERS 检查表的方法。通过定量和定性分析来评估质量。评分稳健性通过 Kendall 一致性系数和类间相关系数进行检验。结果共入选23篇文章。成本分析的主要地理区域是加拿大 (n = 5)、法国 (n = 4) 和美国 (n = 4)。最常研究的病理和技术分别是前列腺 (n = 7) 和头颈癌 (n = 5) 以及 IMRT (n = 8) 和 IGRT (n = 2)。平均工具得分显示了相当程度的方法学质量，CHEC 为 69.7%，QHES 为 73.6%，报告质量以及 CHEERS 的报告质量为 59.4%（74.4%、71.5% 和 66.1 %，分别为时期 2)。每个标准的附加定性分析显示，对于理解成本计算方法和结果（例如，时间范围、贴现率、敏感性分析）必不可少的某些项目通常只部分完成。统计分析证实，审稿人的评分是一致的。这些工具确定了相同的前三篇文章，尽管排名有所不同。结论 EBRT 成本分析的定性和定量评估在方法和报告透明度方面表现出相当水平的研究质量。成本计算对最终 HEE 结果的影响似乎被低估了，需要提高数据来源和方法的透明度。对于理解成本计算方法和结果（例如，时间范围、贴现率、敏感性分析）至关重要，通常只是部分完成。统计分析证实，审稿人的评分是一致的。这些工具确定了相同的前三篇文章，尽管排名有所不同。结论 EBRT 成本分析的定性和定量评估在方法和报告透明度方面表现出相当水平的研究质量。成本计算对最终 HEE 结果的影响似乎被低估了，需要提高数据来源和方法的透明度。对于理解成本计算方法和结果（例如，时间范围、贴现率、敏感性分析）至关重要，通常只是部分完成。统计分析证实，审稿人的评分是一致的。这些工具确定了相同的前三篇文章，尽管排名有所不同。结论 EBRT 成本分析的定性和定量评估在方法和报告透明度方面表现出相当水平的研究质量。成本计算对最终 HEE 结果的影响似乎被低估了，需要提高数据源和方法的透明度。统计分析证实，审稿人的评分是一致的。这些工具确定了相同的前三篇文章，尽管排名有所不同。结论 EBRT 成本分析的定性和定量评估在方法和报告透明度方面表现出相当水平的研究质量。成本计算对最终 HEE 结果的影响似乎被低估了，需要提高数据来源和方法的透明度。统计分析证实，审稿人的评分是一致的。这些工具确定了相同的前三篇文章，尽管排名有所不同。结论 EBRT 成本分析的定性和定量评估在方法和报告透明度方面表现出相当水平的研究质量。成本计算对最终 HEE 结果的影响似乎被低估了，需要提高数据来源和方法的透明度。