The Quality Assessment of Reporting Methods and Results of Cost-Effectiveness Analyses Conducted on the Indian Population: A Methodological Systematic Review

OBJECTIVES: Since the early 2000s, the conduct and publication of cost-effectiveness studies in India have increased significantly. However, the reporting and methodological quality of such studies remain uncertain. Hence, this study aimed to assess the reporting and methodological quality of cost-effectiveness studies conducted on the Indian population. METHODS: We conducted a systematic search for cost-effectiveness evaluations on the Indian population using PubMed, Cochrane Library, and Google Scholar. Quality-adjusted life-years (QALYs) were provided as an outcome measure in all cost-effectiveness analyses that we included. Four reviewers independently extracted data using a custom data collection form designed to capture study reporting details. The Quality of Health Economic Studies and Consensus on Health Economic Criteria checklists were used to assess the quality of each included study. Descriptive analysis was used to examine the data. RESULTS: A total of 61 studies were included. 53 (86.9%) were model-based (mainly Markov models), and 21 (34.4%) used an active comparator. Effectiveness data were primarily drawn from single studies (25, 40.9%), and only 18 (29.5%) used evidence synthesis. Domain-based quality assessment revealed major gaps in several methodological areas. Although most studies adequately defined their perspective (NHS 47.5%, societal 34.4%, both 18.0%) and applied discounting (86.9%), fewer reported sufficient detail on costing methods (75.4%) and especially QALY derivation (24.6%). Only 19 (31.1%) validated their models, and fewer than half (30, 49.1%) quantified uncertainty using confidence intervals. Overall, 37.6% of studies were of moderate to low quality by Consensus on Health Economic Criteria, and 32.8% were rated poor by Quality of Health Economic Studies, reflecting persistent methodological inconsistencies across key domains such as costing, effectiveness sourcing, and model validation. CONCLUSIONS: Overall, Indian cost-effectiveness studies demonstrate moderate methodological quality, but gaps including incomplete reporting of QALY derivation, limited use of evidence synthesis, and inadequate model validation and uncertainty analysis were found. Strengthening methodological rigor and transparency across these domains is essential to enhance the reliability and policy relevance of future economic evaluations in India.