THIRTY YEARS OF THE ECHO MODEL: A BIBLIOMETRIC ANALYSIS OF ITS GLOBAL INFLUENCE ON HEALTH ECONOMICS AND OUTCOMES RESEARCH
Author(s)
Bryan L. Love, PharmD, MPH, Tessa J. Hastings, PhD, Ismaeel U. Yunusa, PharmD, PhD, Chao Cai, PhD, Chengwen Teng, MS, RPh, PharmD, PhD;
University of South Carolina, Clinical Pharmacy and Outcomes Sciences, Columbia, SC, USA
University of South Carolina, Clinical Pharmacy and Outcomes Sciences, Columbia, SC, USA
OBJECTIVES: The Economic, Clinical, and Humanistic Outcomes (ECHO) model, introduced by Kozma et al. in 1993, provided the first framework for assessing the value of pharmaceutical products and services across economic, clinical, and humanistic (patient-centered) domains. This study aimed to quantify and characterize the global research output referencing the ECHO model since its introduction.
METHODS: A bibliometric analysis was conducted on publications citing the ECHO model using PubMed, Scopus, Web of Science, and Dimensions (1993 to 2025). Metadata, including authors, journals, countries, institutions, citations, keywords, and journal metrics, were extracted, harmonized, and deduplicated. Quantitative and qualitative analyses were performed using Microsoft Excel and Bibliometrix (R) to examine descriptive metrics, collaboration patterns, and thematic evolution.
RESULTS: A total of 345 unique documents from 166 sources were identified. Most publications were research articles (n=194; 56.2%) or reviews (n=83; 24.1%), with a mean document age of 14.2 years and 23.3 citations per document. Research in Social and Administrative Pharmacy (n=20; 6.3%) and American Journal of Health-System Pharmacy (n=16; 5.0%) were the most frequent journals. The dataset included 1,004 authors, primarily affiliated with the United States (n=284), Australia (n=238), and Spain (n=134). There were 61 single-authored publications, and co-authored publications averaged 3.92 authors, with 2.9% involving international collaboration. Thematic analysis revealed persistent core topics (e.g., pharmaceutical care, outcomes), and a shift from foundational pharmaceutical concepts (e.g. quality of life, decision making, drug efficacy) toward applied, patient-centered research (e.g. medication adherence, cost-effectiveness, real-world evidence).
CONCLUSIONS: Research referencing the ECHO model expanded steadily over the past three decades, demonstrating its enduring influence on the field of pharmacoeconomics and health outcomes research. The growth, geographic diversity, and thematic evolution of citing publications highlight the ECHO model’s continued role as a foundational framework for evaluating healthcare value across economic, clinical, and humanistic dimensions.
METHODS: A bibliometric analysis was conducted on publications citing the ECHO model using PubMed, Scopus, Web of Science, and Dimensions (1993 to 2025). Metadata, including authors, journals, countries, institutions, citations, keywords, and journal metrics, were extracted, harmonized, and deduplicated. Quantitative and qualitative analyses were performed using Microsoft Excel and Bibliometrix (R) to examine descriptive metrics, collaboration patterns, and thematic evolution.
RESULTS: A total of 345 unique documents from 166 sources were identified. Most publications were research articles (n=194; 56.2%) or reviews (n=83; 24.1%), with a mean document age of 14.2 years and 23.3 citations per document. Research in Social and Administrative Pharmacy (n=20; 6.3%) and American Journal of Health-System Pharmacy (n=16; 5.0%) were the most frequent journals. The dataset included 1,004 authors, primarily affiliated with the United States (n=284), Australia (n=238), and Spain (n=134). There were 61 single-authored publications, and co-authored publications averaged 3.92 authors, with 2.9% involving international collaboration. Thematic analysis revealed persistent core topics (e.g., pharmaceutical care, outcomes), and a shift from foundational pharmaceutical concepts (e.g. quality of life, decision making, drug efficacy) toward applied, patient-centered research (e.g. medication adherence, cost-effectiveness, real-world evidence).
CONCLUSIONS: Research referencing the ECHO model expanded steadily over the past three decades, demonstrating its enduring influence on the field of pharmacoeconomics and health outcomes research. The growth, geographic diversity, and thematic evolution of citing publications highlight the ECHO model’s continued role as a foundational framework for evaluating healthcare value across economic, clinical, and humanistic dimensions.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR56
Topic
Health Policy & Regulatory
Disease
No Additional Disease & Conditions/Specialized Treatment Areas