Presentation (CTI)

OBJECTIVES: Despite the popularity of using cost-effectiveness analyses (CEA) to assess value and allocate limited resources, there is limited research on how study characteristics may influence cost-saving findings. This analysis explores how CEA characteristics and global burden of disease estimates are associated with cost-saving findings.
METHODS: We used the Tufts CEA Registry to identify CEAs published between 1990 and 2021. We fit a generalized linear model to examine associations between cost-saving findings and various CEA characteristics. Multiple imputations were used to adjust for missing data.
RESULTS: We identified 3,398 cost-effectiveness publications across 197 countries, totaling 27,246 country-level ratios. Papers evaluating multiple or “other” interventions (health behavior, legislation, etc.) were more likely to be found cost-saving than pharmaceuticals. Interventions evaluated against medical procedure/devices or “other” were more likely to be found cost-saving than those compared to “do nothing”. Higher odds of cost-saving results were observed for studies from a societal perspective (vs. healthcare payer) and those with pediatric populations. Newer publications and industry-funded studies were more likely to report cost-saving findings. Immunizations and medical procedures/devices were less likely to report cost-savings than pharmaceuticals. Reduced odds of cost-saving findings were also observed for studies with longer time horizons only; pediatric populations; male or female populations (vs. all); communicable, maternal, neonatal, and nutritional diseases and injuries (vs. non-communicable); low- and lower-middle income countries; and those relevant to East Asia and Pacific, Europe and Central Asia, and South Asia (vs. North America). Conditions with greater global burden of disease were marginally less likely to be cost-saving.
CONCLUSIONS: This exploratory analysis demonstrates that cost-saving vary by intervention, comparator, time horizon, disease, geography, publication year, perspective, and funding. Such variation suggests that study design and contextual factors play an important role in shaping reported economic outcomes, necessitating further research into reporting criteria, potential publication bias, and consequences for resource allocation.