OBJECTIVES: We compared the literatures of two common metrics used in cost-effectiveness analyses: cost per quality-adjusted life years (QALYs) gained and cost per disability-adjusted life year (DALY) averted.

METHODS: We analyzed the Tufts Medical Center Cost-Effectiveness Analysis (CEA) Registry database, containing cost-per-QALY gained studies, and the Global Health CEA Registry database, containing cost-per-DALY averted studies. We documented differences in study characteristics – including intervention type, sponsor, country, and primary disease, and compared the number of available CEAs with regional burden of diseases.

RESULTS: We identified 6,438 cost-per-QALY and 543 cost-per-DALY studies published through 2016 and observed rapid growth in publication rates for both literatures. Cost-per-QALY studies were most likely to examine pharmaceuticals and interventions in high-income countries. Cost-per-DALY studies predominantly focused on infectious disease interventions in low and lower-middle income countries. We found regional discrepancies in the number of published CEAs for diseases and conditions, suggesting “under-studied” areas (e.g., cardiovascular disease in Southeast Asia, East Asia, and Oceania) and “over-studied” areas (e.g., HIV in Sub Saharan Africa) relative to regional disease burden.

CONCLUSIONS: The number of cost-per QALY and cost-per-DALY analyses has grown rapidly with applications to diverse interventions/diseases. Discrepancies between the number of published studies and disease burden suggest funding opportunities for future cost-effectiveness research.