Methods for reviewing economic evaluations of community preventive services: a cart without a horse?

In a health care system with ever-rising demand and limited resources, economic assessment of medical technologies is important for those who make resource allocation decisions that affect the health of populations. Cost-effectiveness analysis (CEA) is the best developed tool available for comparing the relative health benefits for expenditure among a myriad of available health interventions. Although guidelines for systematic reviews of economic evaluations in community prevention presented in the American Journal of Preventive Medicine address the issue of facilitating comparison of programs, other issues that limit usefulness of CEA to decision-makers in the field arise. The issues include availability of studies, poorly developed and inconsistent evaluations, omission of key resources from the CEA in community prevention, and shifts in public awareness, social norms, and technologic improvements. Extensive discussion of these issues is provided in the article. In conclusion, the methods for systematic review of economic evaluations in the American Journal of Preventive Medicine are important steps. However, it is advisable to use caution in applying them.