Trends in Publication of Budget Impact and Cost Utility Analyses from 2000-2022 in the United States

OBJECTIVES: The cost of healthcare technologies (affordability and value) continues to increase in importance to US population decision makers. Given this focused attention, this study aimed to evaluate trends in the public dissemination of US health economic evaluations from 2000-2022, specifically budget impact and cost utility analyses (BIA and CUA).

METHODS: A literature search in PubMed and Embase was performed to identify publications (manuscripts/abstracts) in 2000, 2005, 2010, 2015, 2020, and 2022. All publications reflected a US perspective with BIA publications requiring an outcome focused on cost per member per month (PMPM) or net PMPM and CUA publications requiring an outcome focused on the incremental cost effectiveness ratio (ICER), specifically cost/quality-adjusted life year (QALY). Descriptive analysis was conducted by calendar year including publication counts, rates (out of all publications published that year), and characteristics (e.g., therapeutic area).

RESULTS: Absolute numbers and rates of publication increased from 2000 to 2022 for BIAs and CUAs (BIA: N=0 vs N=46; 0 vs 21 per 1,000,000 publications; CUA: N=11 vs n=71; 19 vs 33 per 1,000,000 publications). While CUA publications are more common, BIA publications increased at a higher rate; CUA publication rate peaked in 2015 (36 per 1,000,000 publications).

In the most recent year (2022), 35% of BIAs and 76% of CUAs were manuscripts. Across 2022 BIA and CUA publications, oncology was the most common therapeutic area and most evaluated pharmaceuticals. In 2020, BIA and CUA publications had similar mean impact factors (5.64 vs 5.07), but in 2022 CUA publications were much higher (+4.93; 3.14 vs 8.07).

CONCLUSIONS: Publication patterns of BIAs and CUAs suggest that there is a growing trend by researchers to communicate the affordability and value of new healthcare technologies. Future research should explore such patterns compared to Ex-US markets and include a broader set of health economic study types.