Scope and quality of economic evaluations of Aboriginal and Torres Strait Islander health programs: a systematic review

Objectives: Identify the number, type, scope and quality of economic evaluations of Aboriginal and Torres Strait Islander health programs. Methods: A systematic review of peer-reviewed and grey literature was conducted for articles published from 2010 to 2020 that reported a full economic evaluation of Aboriginal and Torres Strait Islander health programs. Data extraction included: type of economic evaluation, comparators, data sources and concerns, and outcome measures. Methodological quality was assessed using the Drummond checklist. Results: Thirteen publications met inclusion criteria: two cost-consequence analyses, two cost-effectiveness analyses, five cost-utility analyses, and four cost-benefit/return on investment analyses. Most studies (n=10) adopted a health system perspective and used a range of key data sources for economic analyses. Ten studies identified data access limitations that restricted analyses and two studies identified data quality concerns. Twelve studies were of good methodological quality and one was of average quality. Conclusions: Despite significant investment in strategies to close the gap in health outcomes for Aboriginal and Torres Strait Islander people, there is limited evidence about what constitutes a cost-effective investment in Aboriginal and Torres Strait Islander healthcare. Implications for public health: More economic evaluation is required to justify the significant investment in health programs for Aboriginal and Torres Strait Islander people.