Economic evaluations in undergraduate medical education: a systematic review

OBJECTIVES: 

Medical education profoundly impacts patients, students, educators and public resources. However, the economic dimensions necessary for informed decision-making remain underexplored. This systematic review examines how economic evaluations are conducted and reported in undergraduate medical education (UME) literature and assesses their quality.

DESIGN: 

Systematic review. 

DATA SOURCES: 

Medline, Embase, Web of Science, Cochrane, ERIC, Google Scholar and the CEVR CEA databases were searched on 13 September 2024. 

ELIGIBILITY CRITERIA: 

Eligible studies evaluated interventions within UME and reported (incremental) costs and effects, employing any method such as cost-effectiveness analysis, cost-minimisation analysis or decision-analytic modelling. 

DATA EXTRACTION AND SYNTHESIS: 

Key data, including study characteristics, evaluation type, perspective, intervention details, sensitivity analyses, cost and effect measures, outcomes, expressions of cost-effectiveness and adherence to economic reporting guidelines, were extracted. Quality was assessed using the CHEQUE tool, and the findings were synthesised qualitatively. 

RESULTS:

Of 6559 studies identified, 21 met the inclusion criteria. Most studies reported costs and effects post-hoc within effectiveness trials, with only one decision-analytic modelling study identified. Evaluated domains included instructional methods, skills training, selection and student health. All but one study adopted a payer (university) perspective, and nearly all focused on short-term outcomes. Sensitivity analyses were rarely performed, and no study achieved full quality scores. 

CONCLUSIONS: 

Economic evaluations in UME are scarce and often of limited methodological rigour. A shift towards comprehensive, prospective evaluations is needed to address long-term outcomes, societal perspectives and methodological robustness. Such efforts will enable better resource allocation, enhance the impact of medical education and contribute to a sustainable educational landscape. 

PROSPERO REGISTRATION NUMBER: 

CRD42023478907.