Trial-Based Economic Evaluations Conducted alongside Studies Embedded in Australian Healthcare Services and Programs: A Scoping Review.

Abstract

Objectives: The objective of this study was to map the literature and provide an overview of economic evaluations (EEs) conducted alongside studies embedded in Australian healthcare services or programs by: (1) providing a broad overview of the volume, characteristics and types of EEs and (2) examining the subset of EEs impacting older Australians in greater depth including characteristics (type, costs, outcomes, perspectives adopted, time horizon) and quality.

Methods: We conducted a scoping review of full trial-based EEs of studies embedded in Australian healthcare services and programs, published in peer-reviewed journal publications. Medline, Informit, ProQuest Central, Web of Science, Econlit, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cost-Effectiveness Analysis (CEA) Registry, and the International Health Technology Assessment (HTA) database were searched from inception to May 2025. Quality assessment was conducted using the Consensus Health Economic Criteria (CHEC-list).

Results: We identified 88 articles (86 studies) reporting 107 EEs. Cost-effectiveness analyses (CEA) were most common (n = 53, 50%). Most interventions were delivered in ambulatory care settings (n = 41, 47%) and included participants from metropolitan areas (n = 81, 92%). A total of 28 studies (29 comparisons) were with older adults, reporting 38 EEs. Among these, CEAs (n = 16, 42%) and adoption of a health system perspective (n = 11, 29%) were most frequent. Most EEs included intervention costs (n = 25, 86%) and healthcare costs (n = 28, 97%). Most interventions evaluated in CEA and cost-utility analysis were found to be more costly and more effective (n = 16, 43%) or less costly and more effective (n = 15, 41%). The median CHEC-list was 16/19 (IQR 13-17).

Conclusions: Our review identified a diverse range of intervention types and evaluation methods, but a relative lack of cost-benefit analyses, despite their value for cross-sector comparisons. Most evaluations were conducted in metropolitan settings and few incorporated broader costs such as aged care, particularly regarding interventions targeting older adults. Future research should prioritize evaluations that include rural and remote populations and adopt broader perspectives, ensuring the full value of interventions is captured to better inform policy and decision-making.