OBJECTIVES : In recent decades, there have been sustained efforts to improve cancer and other health conditions (henceforth called non-cancer conditions) through cost-effective evidence-based primary, secondary, and tertiary prevention levels. Given limited health resources, sound evidence on the trends of cost-effectiveness of these prevention efforts is essential. We systematically updated and extended cost-utility analysis (CUA) studies in cancer and non-cancer conditions to ascertain their cost-effectiveness.

METHODS : We conducted a systematic review using the Tufts Medical Center Cost-Effectiveness Analysis (CEA) Registry (www.cearegistry.org), a repository of all English-language studies indexed in PubMed reporting cost-per-quality-adjusted life-year ($/QALY) gained. The registry contained >16,600 original incremental cost-effectiveness ratios (ICERs) published in peer-reviewed literature from 1990 through 2016. The reported CUAs were stratified by levels of prevention (primary, secondary, and tertiary prevention).

RESULTS : Overall, there were 1,093 cancer CUAs (3,014 ICERs) and 4,734 non-cancer CUAs (13,114 ICERs) published in the study period. The median ICERs associated with these CUAs (in 2016 US $) were $27,000 for cancer and $15,000 for non-cancer conditions. By prevention level, the reported median ICERs for primary, secondary and tertiary cancer prevention were $22,500, $34,000, and $27,000, respectively. For non-cancer conditions, the median ICERs were $21,000, $18,000, and $13,000, respectively. Among specific cancer sites, breast cancer was the most often studied with 24.4% of reported CUAs and median ICER of $36,000. For non-cancer conditions, cardiovascular disease was the most studied with 21.2% of CUAs and median ICER of $16,000.

CONCLUSIONS : Across all cancer and non-cancer conditions, the median ICERs fell under what is conventionally considered to be most cost-effective (<$50,000/QALY). The reported findings may provide health decision-makers with valuable information to help design and implement effective evidence-based interventions that can contribute in improving life expectancy and quality of life of the population.

Note: We are in the process of updating data reported here to 2018.