The underreporting of cost perspective in cost-analysis research: A systematic review of the plastic surgery literature.

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Cost-analysis research can influence healthcare policies and practices. There is inherent bias depending on the chosen cost perspective (hospital, third-party payer, societal), and conclusions can change based on the perspective used. These perspectives may or may not be well declared or justified when performing cost-analysis research. The goal of this study was to perform a literature review of cost-analysis research in the Plastic Surgery literature to determine the prevalence of studies declaring and justifying their perspective, and to inform the reader on why such declarations are important in understanding potential bias.


A systematic review was completed to retrieve cost-utility and cost-effectiveness research within the scope of Plastic Surgery. The search was limited to English-language studies in North America and Europe published between 2006 and 2016. Articles were selected using predefined data fields and specific inclusion criteria.


A total of 2304 abstracts were identified, of which 47 met inclusion criteria. Seventy-two percent of studies (n = 34) declared a cost perspective. Of the studies that identified a cost perspective, 32% incorrectly identified the cost perspective. Only 49% of all studies (n = 23) both accurately declared and justified their chosen perspective.


Only half of studies correctly declare their cost perspective and justify why the perspective was chosen. Not doing so potentially hides bias from the reader. Future efforts when performing cost-analysis studies should require a clear declaration and justification of the cost perspective taken. A table of our recommendations for reporting cost perspective is provided.

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