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Methods
We reviewed studies published in English on the costs and resource use for rubella and CRS and the costs, cost-effectiveness or cost-benefit of rubella vaccination between 1970 and 2012. This review is up-to-date as of December 1 2012 and conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
We performed a systematic search of MEDLINE (PubMed) and the National Health Services Economic Evaluation Database. Our search strategy included the following terms: 'rubella and economics', 'rubella and costs', 'rubella and cost-effectiveness', 'rubella and cost-utility', 'rubella and cost-benefit', 'CRS and economics', and 'CRS and costs'. The search limits were set to the custom range of dates as described above. The studies identified were reviewed one-by-one by reading their abstracts and identifying the design of the study as reported. The review included health economic evaluations i.e. cost analyses, cost-effectiveness analyses, cost-utility analyses, cost-benefit analyses, cost-consequences analyses, and cost-minimization analyses. The economic evaluation studies were further reviewed to identify any references that did not show up in the initial search.
After reviewing the studies chosen, we categorized them by study design and income level of countries in which they were performed. We used the World Bank definition, which categorizes countries according to Gross National Income (GNI) per capita in 2011 as follows: low income, $1,025 or less; lower middle income, $1,026 - $4,035; upper middle income, $4,036 - $12,475; and high income, $12,476 or more. For the cost-effectiveness and cost-utility analyses, we used the 16-item Quality of Health Economics Studies (QHES) questionnaire to assess study quality. This validated instrument can be used to quickly and accurately measure aspects of the quality of health economics studies on a scale of 0 – 100 and has been used to identify evidence to enhance decision making. A higher score on the QHES indicates a study of better quality. We used the results to identify potential gaps in the evidence on the economics of CRS and rubella vaccination as it relates to the planned expansion of RCV and the potential for the global interruption of rubella transmission.
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