Systematic reviews of cost-effectiveness in low and middle income countries: a review of reviews

We investigate whether systematic reviews of cost-effectiveness analyses of interventions in low and middle income countries are feasible and useful. To this aim, we systematically review systematic reviews of cost-effectiveness studies and systematic reviews of effectiveness studies. We find 27 systematic reviews of cost-effectiveness studies, predominantly of health interventions. We look at the methodologies employed by these reviews to summarise the results of the original studies and we look at the policy recommendations they provide. We conclude that systematic reviews of cost-effectiveness studies in developing countries are few and that their ability to provide policy recommendations is very limited. The paucity of cost-effectiveness analyses in developing countries and the difficulty to summarise the results of diverse cost-effectiveness analyses in a meaningful way are major problems. We suggest that the collection of cost data along impact evaluations and methodological development in the summary of cost-effectiveness ratios across studies constitute a more promising approach.