Skip to main content Accessibility help


  • Olena Mandrik (a1), Saskia Knies (a2), Zoltan Kalo (a3) and Johan L. Severens (a4)


Objectives: The aim of this study is to analyze the quality and transferability issues reported in published peer-reviewed English-language economic evaluations based in healthcare settings of the Central and Eastern European (CEE) and former Soviet countries.

Methods: A systematic search of economic evaluations of healthcare interventions was performed for Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Turkmenistan, Kazakhstan, Lithuania, the former Yugoslav Republic of Macedonia, Republic of Moldova, Romania, the Russian Federation, Serbia, Slovenia, and Ukraine. The included studies were assessed according to their characteristics, quality (using Drummond's checklist), use of local data, and the transferability of inputs and results, if addressed.

Results: Most of the thirty-four economic evaluations identified were conducted from a healthcare or payer perspective (74 percent), with 47 percent of studies focusing on infectious diseases. The least frequently and transparently addressed parameters were the items’ stated perspectives, relevant costs included, accurately measured costs in appropriate units, outcomes and costs credibly valued, and uncertainties addressed. Local data were often used to assess unit costs, baseline risk, and resource usage, while jurisdiction-specific utilities were included in only one study. Only 32 percent of relevant studies discussed the limitations of using foreign data, and 36 percent of studies discussed the transferability of their own study results to other jurisdictions.

Conclusions: Transferability of the results is not sufficiently discussed in published economic evaluations. To simplify the transferability of studies to other jurisdictions, the following should be comprehensively addressed: uncertainty, impact of influential parameters, and data transferability. The transparency of reporting should be improved.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.


Hide All
1. Bingefors, K, Pashos, PC, Smith, MD, Berger, ML. Health care cost, quality, and outcomes: ISPOR book of terms. Lawrenceville, NJ: International Society for Pharmacoeconomics & Outcomes Research; 2003.
2. Dankó, D. Health technology assessment in middle-income countries: Recommendations for a balanced assessment system. J Mark Access Health Policy. 2014;2:110.
3. Drummond, M, Brown, R, Fendrick, AM, et al. Use of pharmacoeconomics information — Report of the ISPOR Task Force on use of pharmacoeconomic/health economic information in health-care decision making. Value Health. 2003;6:407416.
4. The World Bank. Middle income countries overview; 2011. (accessed May 17, 2014).
5. Kolasa, K, Kalo, Z, Zah, V, Dolezal, T. Role of health technology assessment in the process of implementation of the EU Transparency Directive: Relevant experience from Central Eastern European countries. Expert Rev Pharmacoecon Outcomes Res. 2012;12:283287.
6. Gulácsi, L, Orlewska, E, Péntek, M. Health economics and health technology assessment in Central and Eastern Europe: A dose of reality. Eur J Health Econ. 2012;13:525531.
7. Kaló, Z, Bodrogi, J, Boncz, I, et al. Capacity building for HTA implementation in middle-income countries: The case of Hungary. Value Health Reg Issues. 2013;2:264266.
8. EUnetHTA Work Package 8. EUnetHTA handbook on health technology assessment capacity building. catalan agency for health technology assessment and research. Catalan health service. Department of health autonomous government of Catalonia Barcelona, Spain: EUnetHTA; 2008.
9. Centre for Reviews and Dissemination. Systematic reviews: CRD's guidance for undertaking systematic reviews in health care. University of York, York: Centre for Reviews and Dissemination; 2009.
10. Drummond, M, Barbieri, M, Cook, J, et al. Transferability of economic evaluations across jurisdictions: ISPOR good research practices task force report. Value Health. 2009;12:409418.
11. Drummond, MF, Sculpher, MJ, Torrance, GW, O’Brien, BJ, Stoddart, GL. Methods for the economic evaluation of health care programmes. Third edition. Oxford: Oxford University Press; 2005.
12. Barbieri, M, Drummond, M, Rutten, F, et al. What do international pharmacoeconomic guidelines say about economic data transferability? Value Health. 2010;13:10281037.
13. At’kov, OY, Azarov, AV, Zhukov, DA, Nicoloyannis, N, Durand, L. Influenza vaccination in healthy working adults in Russia. Observational study of effectiveness and return on investment for the employer. Appl Health Econ Health Policy. 2011;9:8999.
14. Alistar, SS, Owens, DK, Brandeau, ML. Effectiveness and cost effectiveness of expanding harm reduction and antiretroviral therapy in a mixed HIV epidemic: A modeling analysis for Ukraine. PLoS Med. 2011;8:e1000423.
15. Berkhof, J, Bogaards, JA, Demirel, E, et al. Cost-effectiveness of cervical cancer prevention in Central and Eastern Europe and Central Asia. Vaccine. 2013; 31 (Suppl 7):7179.
16. Cecchini, M, Sassi, F, Lauer, JA, et al. Chronic diseases: Chronic diseases and development. Tackling of unhealthy diets, physical inactivity, and obesity: Health effects and cost-effectiveness. Lancet. 2010;376:17751784.
17. Cornier, N, Petrova, E, Cavailler, P, et al. Optimising the management of vaginal discharge syndrome in Bulgaria: Cost effectiveness of four clinical algorithms with risk assessment. Sex Transm Infect. 2010;86:303309.
18. De Smedt, D, Kotseva, K, De Bacquer, D, et al. Cost-effectiveness of optimizing prevention in patients with coronary heart disease: The EUROASPIRE III health economics project. Eur Heart J. 2012;33:28652872.
19. Floyd, K, Hutubessy, R, Kliiman, K, et al. Cost and cost-effectiveness of multidrugresistant tuberculosis treatment in Estonia and Russia. Eur Respir J. 2012;40:133142.
20. Griffiths, UK, Clark, A, Shimanovich, V, et al. Comparative economic evaluation of haemophilus influenzae Type b vaccination in Belarus and Uzbekistan. PLoS One. 2011;6:e21472.
21. Ivanova, A, Petrova, G, Wrona, W, et al. Modelling the long-term effect of diabetes therapy. An example with liraglutide. Comptes rendus de l’Acad´emie bulgare des Sci. 2011;64:449456.
22. Janković, SM, Kostić, M, Radosavljević, M, et al. Cost-effectiveness of four immunomodulatory therapies for relapsingremitting multiple sclerosis: A Markov model based on data a Balkan country in socioeconomic transition. Vojnosanit Pregl. 2009;66:556562.
23. Jit, M, Yuzbashyan, R, Sahakyan, G, Avagyan, T, Mosina, L. The cost-effectiveness of rotavirus vaccination in Armenia. Vaccine. 2011;29:91049111.
24. Kamusheva, MS, Gerasimov, N, Petrova, GI. Intestinal gel Levodopa + Carbidopa in Parkinson's patients with frequent and prolonged akinesia – An economic evaluation. Int J Pharm Sci Rev Res. 2013; 22:244246.
25. Lakić, D, Bogavac-Stanojević, N, Jelić-Ivanović, Z, et al. A multimarker approach for the prediction of coronary artery disease: Cost-effectiveness analysis. Value Health. 2010;13:770777.
26. Lakić, D, Petrova, G, Bogavac-Stanojević, N, Jelić-Ivanović, Z, Kos, M. The cost-effectiveness of hypertension pharmacotherapy in Serbia: A Markov model. Biotechnol & Biotechnol Eq. 2012;26:30663072.
27. Mihajlović, J, Pechlivanoglou, P, Sabo, A, Tomić, Z, Postma, MJ. Cost-effectiveness of everolimus for second-line treatment of metastatic renal cell carcinoma in Serbia. Clin Ther. 2013;35:19091922.
28. Naversˇnik, K, Mrhar, A. Cost-effectiveness of a novel e-health depression service. Telemed J E Health. 2013;19:110116.
29. Nizalova, O, Vyshnya, M. Evaluation of the impact of the mother and infant health project in Ukraine. Health Econ. 2010;19 (Suppl):107125.
30. Obradovic, M, Mrhar, A, Kos, M. Cost-effectiveness analysis of HPV vaccination alongside cervical cancer screening programme in Slovenia. Eur J Public Health. 2010;20 (4):415421.
31. Perikhanyan, A. Effectiveness and cost-effectiveness of coronary artery bypass surgery versus drug eluting stents in Armenia: A feasibility study. Georgian Med News. 2011;:4451.
32. Petrova, G, Ivanova, A, Czech, M, et al. Liraglutide vs. exenatide in combination with metformin and/or sulfonylurea therapy in type 2 diabetes mellitus therapy in bulgaria. A modelling study. Comptes rendus de l’Acad´emie bulgare des Sci. 2011;64:15071514.
33. Sava, FA, Yates, BT, Lupu, V, Szentagotai, A, David, D. Cost-effectiveness and cost-utility of cognitive therapy, rational emotive behavioral therapy, and fluoxetine (Prozac) in treating depression: A randomized clinical trial. J Clin Psychol. 2009;65:3652.
34. Sirli, R, Sporea, I, Martie, A, Popescu, A, Dănilă, M. Contrast enhanced ultrasound in focal liver lesions–A cost efficiency study. Med Ultrason. 2010;12:280285.
35. Smit, R. Explanation of “cost-effectiveness of tick-borne encephalitis vaccination in Slovenian adults”. Vaccine. 2014;32:12271228.
36. Bogavac-Stanojević, N, Dopsaj, V, Jelić-Ivanović, Z, et al. Economic evaluation of different screening alternatives for patients with clinically suspected acute deep vein thrombosis. Biochem Med (Zagreb). 2013;23:96106.
37. Jasmina, T, Genchev, G, Savova, A, Dantchev, N, Petrova, G. Cost-effectiveness and activities of daily living in patients with complex regional pain syndrome type I. Int J Pharm Sci Rev Res. 2012;17:1621.
38. Tole, SP, Sanders, GD, Bayoumi, AM, et al. Cost-effectiveness of voluntary HIV screening in Russia. Int J STD AIDS. 2009;20:4651.
39. Uusküla, A, Müürsepp, A, Kawai, K, et al. The epidemiological and economic impact of a quadrivalent human papillomavirus (HPV) vaccine in Estonia. BMC Infect Dis. 2013;13:304.
40. Valov, V, Palmer, J, Czech, M, Savova, A, Petrova, G. Cost-effectiveness of biphasic insulin aspart 30 vs. human premix insulin in type 2 diabetes from the payer's perspective in Bulgaria. Biotechnol Biotechnol Eq. 2012;26:29372944.
41. Vanagas, G, Padaiga, Z. Healthcare spending in the case of a HPV16/18 population-wide vaccination programme. Scand J Public Health. 2012;40:406411.
42. Vanagas, G, Padaiga, Z, Kurtinaitis, J, Logminiene, Z. Cost-effectiveness of 12- and 15-year-old girls’ human papillomavirus 16/18 population-based vaccination programmes in Lithuania. Scand J Public Health. 2010;38:639647.
43. Vanagas, G, Padaiga, Z, Mickevičienė, A. Cost-effectiveness and cost-utility of the treatment of chronic hepatitis B with peginterferon alfa-2a, interferon alfa, and lamivudine in Lithuania. Medicina (Kaunas). 2010;46:835842.
44. Vanagas, G, Padaiga, Z, Bagdonas, E. Cost-utility analysis of methadone maintenance treatment in Lithuania. Medicina (Kaunas). 2010;46:286292.
45. Vassall, A, Chechulin, Y, Raykhert, I, et al. Reforming tuberculosis control in Ukraine: Results of pilot projects and implications for the national scale-up of DOTS. Health Policy Plan. 2009;24:5562.
46. Winetsky, DE, Negoescu, DM, DeMarchis, EH, et al. Screening and rapid molecular diagnosis of tuberculosis in prisons in Russia and Eastern Europe: A cost-effectiveness analysis. PLoS Med. 2012;9:e1001348.
47. Tran, BX, Nong, VM, Maher, RM, Nguyen, PK, Luu, HN. A systematic review of scope and quality of health economic evaluation studies in vietnam. PLoS One. 2014;9:e103825.
48. Knies, S, Severens, JL, Ament, AJ, Evers, SM. The transferability of valuing lost productivity across jurisdictions. Differences between national pharmacoeconomic guidelines. Value Health. 2010;13:519527.
49. Hay, JW, Smeeding, J, Carroll, NV, et al. Good research practices for measuring drug costs in cost effectiveness analyses: Issues and recommendations: The ISPOR Drug Cost Task Force Report—Part I. Value Health. 2010;13:37.
50. Welte, R, Feenstra, T, Jager, H, Leidl, R. A decision chart for assessing and improving the transferability of economic evaluation results between countries. Pharmacoeconomics. 2004;22:857876.
51. Erntoft, S. Pharmaceutical priority setting and the use of health economic evaluations: A systematic literature review. Value Health. 2011;14:587599.
52. Husereau, D, Drummond, M, Petrou, S, et al. CHEERS Task Force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. BMJ. 2013;346:f1049.
53. McGhan, WF, Al, M, Doshi, JA, et al. The ISPOR Good Practices for Quality Improvement of Cost-Effectiveness Research Task Force Report. Value Health. 2009;12:10861099.
54. Goeree, R, Burke, N, O’Reilly, D, et al. Transferability of economic evaluations: Approaches and factors to consider when using results from one geographic area for another. Curr Med Res Opin. 2007;23:671682.
55. Knies, S, Evers, SM, Candel, MJ, Severens, JL, Ament, AJ. Utilities of the EQ-5D: Transferable or not? Pharmacoeconomics. 2009;27:767779.
56. Goeree, R, He, J, O’Reilly, D, et al. Transferability of health technology assessments and economic evaluations: A systematic review of approaches for assessment and application. Clinicoecon Outcomes Res. 2011;3:89104.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed