Identifying priority technical and context-specific issues in improving the conduct, reporting and use of health economic evaluation in low- and middle-income countries

Table 4 Ranked technical issues, presented as groups of related issues and by rank

Priority rank	Technical issue	Score	Frequency in first rank
Lack of relevant data
1	Lack of high-quality local clinical data, where such data are critical to the decision	80	21%
3	Insufficient data to conduct study from chosen perspective	57	9%
5	Absence of locally relevant health state preference data suitable for estimating QALYs or DALYs	43	7%
Lack of commonly accepted standard or methods
2	Poor reporting	67	21%
4	A lack of commonly accepted standards for economic evaluation that is relevant to the LMIC for which the analysis is undertaken	57	19%
Inappropriate use of methods
6	Inappropriate choice of comparator(s)	29	7%
7	No budget constraints or thresholds considered	26	5%
8	Generalisability not discussed	14	3%
10	Equity and/or gender implications not considered	12	0%
11	No incremental analysis	11	1%
12	No, or inappropriate, sensitivity analysis	10	0%
13	All impacts implied by the chosen perspective not investigated	10	3%
15	Time horizon too short to capture relevant costs and health effects	9	1%
Inappropriate use of data
9	Clinical data not based on systematic review or primary clinical data not compared with similar studies done elsewhere	12	1%
14	Uncritical use of charges for cost data	9	1%