Calidad en revisiones sistemáticas de evaluaciones económicas de tecnologías en salud.
Quality in systematic reviews of economic evaluations of health technologies.
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La toma de decisiones en salud tanto desde el punto de vista clínico como administrativo, requiere entre otros aspectos, fundamentarse tanto en la mejor evidencia producto de investigación de las tecnologías sanitarias como en el mejor uso de los escasos recursos económicos con los que usualmente se cuenta. En el ámbito clínico, las revisiones sistemáticas de ensayos clínicos controlados y aleatorizados, aportan información valiosa al sintetizar la mejor evidencia. Por otro lado, las evaluaciones económicas de tecnologías sanitarias son útiles al proporcionar información comparada entre los costos de dicha tecnología, por unidad de desenlace de la enfermedad en términos usualmente de efectividad o de utilidad. Realizar revisiones sistemáticas de evaluaciones económicas de tecnologías sanitarias en principio podría considerarse una muy buena herramienta para toma de decisiones, sin embargo, es importante considerar que las evaluaciones económicas pueden presentar debilidades metodológicas que limitarían su calidad. Las revisiones sistemáticas de ensayos clínicos cuentan con metodologías claras para realizarlas, incluyendo la evaluación de riesgo de sesgo y calidad tanto de los estudios incluidos, como de la misma revisión. En el caso de las evaluaciones económicas aún existe heterogeneidad en la metodología y falta de estandarización en la forma de evaluar su calidad, lo cual afecta el desarrollo de revisiones sistemáticas de evaluaciones económicas. Sin embargo, en la presente revisión se identifican herramientas que pueden servir para evaluar calidad y riesgo de sesgo de evaluaciones económicas, así como también de las mismas revisiones.
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