OBJECTIVES: Cost-effectiveness analysis (CEA) is sometimes considered by U.S. commercial payers when making coverage and reimbursement decisions, reflecting the important role that CEA plays in informing judgments about health value. However, the extent to which utilities – which are key inputs in CEA studies – equitably account for population gender, race, and ethnicity is unknown.

METHODS: We screened high-impact health care economic evaluation journals (Nov 2019 to Dec 2021) for U.S.-based CEA case studies. We extracted patient demographic information from the source utility-estimating studies and assessed representativeness in comparison with U.S. estimates.

RESULTS: We screened 751 titles and identified 52 published CEAs. We narrowed to a final set of 12 that reported utility values. These CEAs used health state utilities from 28 studies; 17 of the 28 studies calculated utilities from surveys (quality of life [QoL] assessment, time trade-off, standard gamble) of patients or general adult population; 10 drew results from QoL assessments in randomized controlled trials; 1 was a QoL meta-analysis. Most utility studies reported data on participant age (26/28) and gender (22/28), but fewer reported on participant race or ethnicity (16/28). Only 6 studies reported on education level, 3 studies reported employment status, and 1 reported on sexual orientation. All but 2 of the 16 studies (8 surveys and 8 RCTs) reporting race/ethnicity included fewer non-white participants than the US population average (surveys) or disease population (RCTs).

CONCLUSIONS: CEA should rely on data representative of diverse populations to support equity. However, many utility studies in CEAs fail to adequately represent diverse populations and often do not report race/ethnicity or other demographics, making it impossible to assess the representativeness. Improved engagement with diverse populations and increased transparency in reporting demographic elements in health utility and value assessment research are imperative to ensure equity is an important consideration in decision making.