R H Chapman1, P W Stone, E A Sandberg, C Bell, P J Neumann. 1. Program on the Economic Evaluation of Medical Technology, Harvard Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
Abstract
OBJECTIVES: The authors compiled a comprehensive league table of cost/QALY ratios, and a standardized table of analyses satisfying selected Reference Case criteria from the USPHS Panel on Cost-Effectiveness in Health and Medicine. METHODS: They identified 228 cost-utility analyses (CUAs) through literature searches, and abstracted data on methods and cost-utility ratios. The subset of "Panel-worthy" analyses used: a societal or broad health-care perspective, community or patient preference weights, net costs, incremental comparisons, and discounting of costs and QALYs. RESULTS: The 228 CUAs included ratios for 647 interventions, ranging from cost-saving to $52,000,000/QALY (median = $12,000/QALY). The standardized table presents 112 ratios that met the "Panel-worthy" criteria, with articles published in recent years more likely to meet all of the criteria. CONCLUSIONS: The comprehensive league table (available on the Web) provides a useful reference, but ratios may not be comparable because of methodologic variations. The standardized table focuses on studies meeting basic methodologic criteria, potentially allowing for better comparison with future Reference Case analyses. Future studies should investigate the quality of analyses' underlying assumptions in addition to whether certain key procedural protocols were met.
OBJECTIVES: The authors compiled a comprehensive league table of cost/QALY ratios, and a standardized table of analyses satisfying selected Reference Case criteria from the USPHS Panel on Cost-Effectiveness in Health and Medicine. METHODS: They identified 228 cost-utility analyses (CUAs) through literature searches, and abstracted data on methods and cost-utility ratios. The subset of "Panel-worthy" analyses used: a societal or broad health-care perspective, community or patient preference weights, net costs, incremental comparisons, and discounting of costs and QALYs. RESULTS: The 228 CUAs included ratios for 647 interventions, ranging from cost-saving to $52,000,000/QALY (median = $12,000/QALY). The standardized table presents 112 ratios that met the "Panel-worthy" criteria, with articles published in recent years more likely to meet all of the criteria. CONCLUSIONS: The comprehensive league table (available on the Web) provides a useful reference, but ratios may not be comparable because of methodologic variations. The standardized table focuses on studies meeting basic methodologic criteria, potentially allowing for better comparison with future Reference Case analyses. Future studies should investigate the quality of analyses' underlying assumptions in addition to whether certain key procedural protocols were met.