COST-UTILITY ANALYSES OF NEW MEDICAL TECHNOLOGIES- OFTEN COST-EFFECTIVE, SOMETIMES COST-INEFFECTIVE, DOMINANT, OR DOMINATED, BUT ALMOST NEVER “DECREMENTALLY” COST-EFFECTIVE
Author(s)
David M Kent, MD, MS, Assistant Professor1, Joshua T. Cohen, PhD, Lecturer and Research Scientist1, A Mark Fendrick, MD, Professor2, Kenneth M Langa, MD, PhD, Associate Professor2, Peter J. Neumann, ScD, Professor31Tufts-New England Medical Center, Boston, MA, USA; 2 University of Michigan, Ann Arbor, MI, USA; 3 Tufts University School of Medicine, Boston, MA, USA
OBJECTIVES: Technological innovations may be cost-increasing and quality-improving (CIQI), cost-saving and quality-improving (dominant), cost-increasing and quality-decreasing (dominated), or cost-saving and quality-decreasing (CSQD). We endeavored to determine how cost-utility analyses of new medical technologies are distributed across these categories. METHODS: We systematically searched computerized databases including MEDLINE, HealthSTAR, CancerLit, Current Contents and EconLit to identify cost-utility analyses published in 2002 to 2003. Trained auditors summarized each study using standardized forms. All costs were converted to 2002 US dollars. RESULTS: We identified 640 separate published cost utility analyses. These papers compared 657 interventions against a standard. Of analyzed interventions, 79.0% (519) were CIQI, 13.5% (89) were dominant, 6.7% (44) were dominated, but only 0.8% (5) were CSQD. Among CIQI interventions, 64.6% (335) had a cost-effectiveness ratio (CER) below $50,000 per QALY and 79.0% (410) had a CER below $100,000 per QALY. Among CSQD interventions, 60% (3) had a CER below $50,000 per QALY and 2 had a CER above $100,000 per QALY. CONCLUSION: Most published cost-utility analyses are performed on CIQI technologies, and most of these have a CER below conventionally accepted thresholds. Cost-utility analyses of CSQD technologies are extremely rare.
Conference/Value in Health Info
2006-10, ISPOR Europe 2006, Copenhagen, Denmark
Value in Health, Vol. 9, No.6 (November/December 2006)
Code
ES1
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Multiple Diseases