The Changing Face of the Cost-Utility Literature, 1990–2012

Neumann, Peter J.; Thorat, Teja; Shi, Jennifer; Saret, Cayla J.; Cohen, Joshua T.

doi:10.1016/j.jval.2014.12.002

Cited by 90 publications

(55 citation statements)

References 13 publications

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“…Model-based economic evaluations of CVD-related health policies are increasingly common and policy-relevant in the U.S.(34, 35) Specifically, in 2014 the American College of Cardiology/American Heart Association acknowledged that cost-effectiveness should be the basis for determining value in cardiovascular disease health policies, but noted that the primary barrier to shifting towards valued-based case “is the lack of high-quality data on cost and value (cost-effectiveness) of interventions or procedures used in practice.”(35) Our simulation is designed to be flexible enough to evaluate a wide range of CVD-related policies as opposed to being a “single-use” model, which is why we invested in a rigorous external validation against nationally representative, longitudinal data. (36) Selected examples of previous and potential applications of our model include staged screening for CVD risk, identifying high-risk primary aldosteronism patients eligible for intensive CVD prevention procedures, and population-based policies focusing on important health behaviors such as diet and exercise.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Cardiovascular Disease Policy Microsimulation Model Using Both Survival and Receiver Operating Characteristic Curves

Pandya

Cho

et al. 2017

Med Decis Making

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Background Despite some advances, cardiovascular disease (CVD) remains the leading cause of death and healthcare costs in the U.S. We therefore developed a comprehensive CVD policy simulation model that identifies cost-effective approaches for reducing CVD burden. This paper aims to: 1) describe our model in detail; and 2) perform model validation analyses. Methods The model simulates 1,000,000 adults (ages 35–80 years) using a variety of CVD-related epidemiological data, including previously calibrated Framingham-based risk scores for coronary heart disease and stroke. We validated our micro-simulation model using recent National Health and Nutrition Examination Survey (NHANES) data, with baseline values collected in 1999–2000 and cause-specific mortality follow-up through 2011. Model-based (simulated) results were compared to observed all-cause and CVD-specific mortality data (from NHANES) for the same starting population using survival curves and, in a method not typically used for disease model validation, receiver operating characteristic (ROC) curves. Results Observed 10-year all-cause mortality in NHANES versus the simulation model were 11.2% (95% CI: 10.3–12.2%) versus 10.9%; corresponding results for CVD mortality were 2.2% (1.8–2.7%) versus 2.6%. Areas under the ROC curves for model-predicted 10-year all-cause and CVD mortality risks were 0.83 (0.81–0.85) and 0.84 (0.81–0.88), respectively; corresponding results for 5-year risks were 0.80 (0.77–0.83) and 0.81 (0.75–0.87), respectively. Limitations The model is limited by the uncertainties in the data used to estimate its input parameters. Additionally, our validation analyses did not include non-fatal CVD outcomes due to NHANES data limitations. Conclusions The simulation model performed well in matching to observed nationally representative longitudinal mortality data. ROC curve analysis, which has been traditionally used for risk prediction models, can also be used to assess discrimination for disease simulation models.

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Section: Discussionmentioning

confidence: 99%

Validation of a Cardiovascular Disease Policy Microsimulation Model Using Both Survival and Receiver Operating Characteristic Curves

Pandya

Cho

et al. 2017

Med Decis Making

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“…Research has shown rapid growth in the number of published cost-per-QALY studies, with applications to diverse diseases and interventions, but also substantial variability in reporting practices as well disparities between certain conditions (e.g., injuries) with high burden but which have had few associated cost-effectiveness analyses [18]. …”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Cost-Effectiveness Studies Reporting Cost-per-DALY Averted

et al. 2016

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IntroductionCalculating the cost per disability-adjusted life years (DALYs) averted associated with interventions is an increasing popular means of assessing the cost-effectiveness of strategies to improve population health. However, there has been no systematic attempt to characterize the literature and its evolution.MethodsWe conducted a systematic review of cost-effectiveness studies reporting cost-per-DALY averted from 2000 through 2015. We developed the Global Health Cost-Effectiveness Analysis (GHCEA) Registry, a repository of English-language cost-per-DALY averted studies indexed in PubMed. To identify candidate studies, we searched PubMed for articles with titles or abstracts containing the phrases “disability-adjusted” or “DALY”. Two reviewers with training in health economics independently reviewed each article selected in our abstract review, gathering information using a standardized data collection form. We summarized descriptive characteristics on study methodology: e.g., intervention type, country of study, study funder, study perspective, along with methodological and reporting practices over two time periods: 2000–2009 and 2010–2015. We analyzed the types of costs included in analyses, the study quality on a scale from 1 (low) to 7 (high), and examined the correlation between diseases researched and the burden of disease in different world regions.ResultsWe identified 479 cost-per-DALY averted studies published from 2000 through 2015. Studies from Sub-Saharan Africa comprised the largest portion of published studies. The disease areas most commonly studied were communicable, maternal, neonatal, and nutritional disorders (67%), followed by non-communicable diseases (28%). A high proportion of studies evaluated primary prevention strategies (59%). Pharmaceutical interventions were commonly assessed (32%) followed by immunizations (28%). Adherence to good practices for conducting and reporting cost-effectiveness analysis varied considerably. Studies mainly included formal healthcare sector costs. A large number of the studies in Sub-Saharan Africa addressed high-burden conditions such as HIV/AIDS, tuberculosis, neglected tropical diseases and malaria, and diarrhea, lower respiratory infections, meningitis, and other common infectious diseases.ConclusionThe Global Health Cost-Effectiveness Analysis Registry reveals a growing and diverse field of cost-per-DALY averted studies. However, study methods and reporting practices have varied substantially.

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“…Both registries contain information on PubMed-indexed, English-language CEAs published through 2016. Previous publications further detail the search strategies, data collection processes, and review methods, which are similar for both registries 5 6 . We received ethics exemption for this study because it did not involve human subjects.…”

Section: Methodsmentioning

confidence: 99%

“…Analysts have used these measures in different contexts and settings 2 6 . CEAs using the cost-per-QALY metric, which first appeared in the late 1970s, have typically focused on interventions in higher incomes settings 7 8 .…”

Section: Introductionmentioning

confidence: 99%

Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures

et al. 2018

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Background: We examined the similarities and differences between studies using two common metrics used in cost-effectiveness analyses (CEAs): cost per quality-adjusted life years (QALYs) gained and cost per disability-adjusted life year (DALY) averted. Methods: We used the Tufts Medical Center CEA Registry, which contains English-language cost-per-QALY gained studies, and Global Cost-Effectiveness Analysis (GHCEA) Registry, which contains cost-per-DALY averted studies. We examined study characteristics including intervention type, sponsor, country, and primary disease, and also analysed the number of CEAs versus disease burden estimates for major diseases and conditions across three geographic regions. 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 and interventions in low and lower-middle income countries. We found discrepancies in the number of published CEAs for certain diseases and conditions in certain regions, suggesting “under-studied” areas (e.g., cardiovascular disease in Southeast Asia, East Asia, and Oceania and “overstudied” areas (e.g., HIV in Sub Saharan Africa) relative to disease burden in those regions. Conclusions: The number of cost-per QALY and cost-per-DALY analyses has grown rapidly with applications to diverse interventions and diseases. Discrepancies between the number of published studies and disease burden suggest funding opportunities for future cost-effectiveness research.

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The Changing Face of the Cost-Utility Literature, 1990–2012

Abstract: Our review reveals considerable growth and some change in the cost-utility literature in recent years. The data suggest growing interest in cost-utility methodology, particularly in non-Western countries.

Cited by 90 publications

References 13 publications

Validation of a Cardiovascular Disease Policy Microsimulation Model Using Both Survival and Receiver Operating Characteristic Curves

Validation of a Cardiovascular Disease Policy Microsimulation Model Using Both Survival and Receiver Operating Characteristic Curves

A Systematic Review of Cost-Effectiveness Studies Reporting Cost-per-DALY Averted

Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures

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