Cost-Effectiveness Analysis Registry
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The Cost-Effectiveness Analysis Registry was developed by the Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA. The Registry contains detailed information on over 4,900 cost-utility analyses published through 2014. Health-related CEAs estimate the resources used (costs) and the health benefits achieved (effects) for an intervention compared to an alternative treatment strategy. The Registry focuses on a subset of CEAs, called cost-utility analyses (CUAs) that quantify health benefits in terms of quality-adjusted life years (QALYs), a metric that accounts for changes in both longevity and quality of life.
The project website states that the objectives of the Registry are to help decision makers identify society's best opportunities for targeting resources to improve health, to assist policymakers in healthcare resource allocation decisions, and to move the field towards the use of standard methodologies.
The CEA Registry contains data on articles published from 1976 through 2014, including information on more than 13,400 ratios. The Registry website lists 30 academic papers based on the Registry data. It has been used or cited in analyses performed by the Environmental Protection Agency, the Food and Drug Administration, the Institute of Medicine, and the Medicare Payment Assessment Commission. The CEA Registry is also listed on the National Library of Medicine's website as a health economics resource.
The published articles summarized in the Registry undergo a formalized review protocol. These articles address a variety of diseases and treatments and all measure health effects in terms of the QALYs, a standard measure that accounts for quality of life (morbidity) and longevity (mortality). The CEA Registry team searches MEDLINE for English-language articles using keywords "QALYs", "quality-adjusted", and "cost-utility analysis". Abstracts from these articles are screened to determine if the paper contains an original cost-utility estimate. The team excludes review, editorial, or methodological articles, as well as cost-effectiveness analyses that do not use QALYs to quantify health benefits.
Each article meeting these criteria is assigned a disease classification by a clinician. Two readers with training in decision analysis and cost-effectiveness analysis independently review each article and record information using a standardized set of forms and instructions. The two readers convene for a consensus audit to resolve any potential discrepancies. On occasion, a third reader may be called upon to help settle disputed items.
Data on over 40 variables is collected for each article.
The registry reports:
- the type of intervention evaluated
- the country of the analysis
- the funding source.
For methodology, the registry reports
- whether the article correctly calculated incremental cost-utility ratios
- the analytic time horizon and analytic perspective (e.g., societal or health care payer)
- what discount rate, if any was used
- the currency used
- whether the analysis accounted for additional costs associated with greater longevity achieved through treatment
- the type of sensitivity or uncertainty analysis used
- whether the article specified a threshold for identifying acceptably favorable cost-effectiveness ratios
- a subjective assessment regarding of the article’s overall quality on an interval scale from 1 (low) to 7 (high).
The registry describes the health intervention that is the subject of the analysis, and comparator intervention to which it is compared, and the population that is eligible for the intervention. When available, the costs and health benefits (QALYs) associated with both the target and comparator interventions are reported. The registry reports the value of the ratio reported in the original article, as well as the value calculated directly from the cost and health benefit information in the article. The registry also reports the ratio quadrant.
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Utility Weight Information
The registry reports the health condition, utility weight value, and range of plausible values. When used, the registry reports secondary literature sources relied upon to provide utility weight values. In cases where the authors develop their own utility weight values, the registry describes the methodology used.
Recent Articles Using CEA Registry Data
- Thorat T, Lin PJ, Neumann PJ. The State of Cost-Utility Analyses in Asia: A Systematic Review. Value Health Regional Issues. 2015 May 7–13.
- Chambers JD, Thorat T, Pyo J, Neumann PJ. The lag from FDA approval to published cost-utility evidence. Expert Rev Pharmacoecon Outcomes Res. 2015 Jan 12:1-4.
- Saret CJ, Winn A, Shah G, Parsons SK, Lin PJ, Cohen JT, Neumann PJ. Value of innovation in hematologic malignancies: a systematic review of published cost-effectiveness analyses. Blood. 2015 Feb 5.
- Zhong Y, Lin PJ, Cohen JT, Winn AN, Neumann PJ. Cost-Utility Analyses in Diabetes: A Systematic Review and Implications from Real-World Evidence. Value Health. 2015 Mar;18(2):308-314.
- Neumann PJ, Thorat T, Shi J, Saret CJ, Cohen JT. The changing face of the cost-utility literature, 1990-2012. Value Health. 2015 Mar;18(2):271-7.
- Cohen JT. FDA's proposed ban on trans fats: How do the costs and benefits stack up? Clin Ther. 2014 Mar 1;36(3):322-7.
- Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness—the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014 Aug 28;371(9):796-7.
- Chambers JD, Thorat T, Pyo J, Chenoweth M, Neumann PJ. Despite High Costs, Specialty Drugs May Offer Value For Money Comparable To That Of Traditional Drugs. Health Aff (Millwood). 2014 Oct;33(10):1751-60.
- Tetteh E, Morris S. Systematic review of drug administration costs and implications for biopharmaceutical manufacturing. Appl Health Econ Health Policy. 2013 Oct;11(5):445-56.
- Tang DH, Harrington AR, Lee JK, Lin M, Armstrong EP. A systematic review of economic studies on biological agents used to treat Crohn's disease. Inflamm Bowel Dis. 2013 Nov;19(12):2673-94.
- Phillips KA, Ann Sakowski J, Trosman J, Douglas MP, Liang SY, Neumann P. The economic value of personalized medicine tests: what we know and what we need to know. Genet Med. 2013 Nov 14.
- Richards D. Only limited evidence available for the effectiveness and cost effectiveness of dental auxiliaries. Evid Based Dent. 2013;14(2):38-9.
- Olchanski N, Cohen JT, Neumann PJ. A role for research: an observation on preventive services for women. Am J Prev Med. 2013 Jan;44(1 Suppl 1):S12-5.
- Saab S, Choi Y, Rahal H, Li K, Tong M; Choi; Rahal; Li; Tong (December 2012). "Trends in Viral Hepatitis Cost-Effectiveness Studies". Am J Manag Care 18 (12): 790–798. PMID 23286609.
- Chokshi DA, Farley TA (July 2012). "The Cost-Effectiveness of Environmental Approaches to Disease Prevention.". N Engl J Med 367 (4): 295–7. doi:10.1056/nejmp1206268. PMID 22830461.
- Otero HJ, Fang CH, Sekar M, Ward RJ, Neumann PJ; Fang; Sekar; Ward; Neumann (May 2012). "Accuracy, Risk and the Intrinsic Value of Diagnostic Imaging: A Review of the Cost-utility Literature". Acad Radiol 19 (5): 599–606. doi:10.1016/j.acra.2012.01.011. PMID 22342653.
- Wilson AW, Neumann PJ (March 2012). "The cost-effectiveness of biopharmaceuticals: A look at the evidence". MAbs 4 (2): 281–8. doi:10.4161/mabs.4.2.18812. PMC 3361664. PMID 22377753.
- Simoens S (April 2012). "What is the value for money of medicines? A registry study.". J Clin Pharm Ther 37 (2): 182–6. doi:10.1111/j.1365-2710.2011.01277.x. PMID 21812796.
- Finnell SM, Carroll AE, Downs SM; Carroll; Downs (May–June 2012). "Application of classic utilities to published pediatric cost-utility studies". Acad Pediatr 12 (3): 219–28. doi:10.1016/j.acap.2011.09.003. PMID 22075466.
- Miller G, Cohen JT, Roehrig C; Cohen; Roehrig (November 2012). "Cost-effectiveness of cardiovascular disease spending". J Am Coll Cardiol 60 (20): 2123–4. doi:10.1016/j.jacc.2012.02.095. PMC 3495132. PMID 23137531.
- Heijnsdijk EAM, Wever EM, Auvinen A; Wever; Auvinen; Hugosson; Ciatto; Nelen; Kwiatkowski; Villers; Páez; Moss; Zappa; Tammela; Mäkinen; Carlsson; Korfage; Essink-Bot; Otto; Draisma; Bangma; Roobol; Schröder; De Koning (August 2012). "Quality-of-life effects of prostate-specific antigen screening". N Engl J Med 367 (3): 595–605. doi:10.1056/nejmoa1201637. PMID 22894572.
- Greenberg, D; Neumann, PJ (2011), Is it cost-effective? It depends on who you ask. In Rosen B, Israeli A, Shortell S (ed). Improving Health and Healthcare. Who is Responsible? Who is Accountable? The Israel National Institute for Health Policy Research, 2011
- Kamae MS, Kamae I, Cohen JT, Neumann PJ.; Kamae; Cohen; Neumann (February 18, 2011). "Regression analysis on the variation in efficiency frontiers for prevention stage of HIV/AIDS". Journal of Medical Economics 14 (2): 187–93. doi:10.3111/13696998.2011.557111. PMID 21332273.
- Greenberg, D; Neumann, PJ (February 2011). "Does adjusting for health-related quality of life matter in economic evaluations of cancer-related interventions?". Expert Rev. Pharmacoeconomics Outcomes Res 11 (1): 113–119. doi:10.1586/erp.11.1. PMID 21351863.
- Braithwaite RS, Mentor SM (2011). "Identifying Favorable-Value Cardiovascular Health Services". American Journal of Managed Care 17 (6): 431–438.
- Otero HJ, Rybicki FJ, Greenberg D, Mitsouras D, Mendoza JA, Neumann PJ; Rybicki; Greenberg; Mitsouras; Mendoza; Neumann (Aug 2010). "Cost-Effective Diagnostic Cardiovascular Imaging: When Does It Provide Good Value for the Money?". International Journal of Cardiovascular Imaging 26 (6): 605–12. doi:10.1007/s10554-010-9634-z. PMC 2927101. PMID 20446040.
- Chambers JD, Neumann PJ, Buxton MJ; Neumann; Buxton (Jul–Aug 2010). "Does Medicare Have an Implicit Cost-Effectiveness Threshold?". Medical Decision Making 30 (4): E14–27. doi:10.1177/0272989X10371134. PMID 20551473.
- Meckley LM, Greenberg D, Cohen JT, Neumann PJ; Greenberg; Cohen; Neumann (May–Jun 2010). "The adoption of cost-effectiveness acceptability curves in cost-utility analyses". Medical Decision Making 30 (3): 314–9. doi:10.1177/0272989X09344749. PMID 19773582.
- Neumann PJ, Auerbach HR, Cohen JT, Greenberg D; Auerbach; Cohen; Greenberg (2010). ""Low-value" services in value-based insurance design". American Journal of Managed Care 16 (4): 280–286. PMID 20394464.
- Greenberg D, Rosen AB, Wacht O, Palmer JA, Neumann PJ; Rosen; Wacht; Palmer; Neumann (May–Jun 2010). "A bibliometric review of cost-effectiveness analysis in the economic and medical literature, 1976-2007". Medical Decision Making 30 (3): 320–7. doi:10.1177/0272989X09360066. PMID 20228286.
- Greenberg D, Earle CC, Fang CH, Eldar-Lissai A, Neumann PJ; Earle; Fang; Eldar-Lissai; Neumann (2010). "When is cancer care cost-effective? A systematic overview of cost-utility studies in oncology". Journal of the National Cancer Institute 102 (2): 82–88. doi:10.1093/jnci/djp472. PMC 2808348. PMID 20056956.
- Nelson AL, Cohen JT, Greenberg D, Kent DM; Cohen; Greenberg; Kent (Nov 2009). "Much cheaper, almost as good: Decrementally cost-effective medical innovation". Annals of Internal Medicine 151 (9): 662–667. doi:10.7326/0003-4819-151-9-200911030-00011. PMID 19884627.
- Rosen AB, Spaulding A, Greenberg D, Palmer JA, Neumann PJ; Spaulding; Greenberg; Palmer; Neumann (Sep 2009). "Patient adherence: A blind spot in cost-effectiveness analysis?". Am J Manag Care 15 (9): 626–32. PMID 19747027.
- Neumann PJ (2009). "Costing and perspective in published cost-effectiveness analyses". Medical Care 47 (7s1): s28–s32. doi:10.1097/MLR.0b013e31819bc09d. PMID 19536023.
- Neumann PJ, Fang CH, Cohen JT; Fang; Cohen (2009). "30 years of pharmaceutical cost-utility analyses: growth, diversity, and methodological improvement". PharmacoEconomics 27 (10): 861–872. doi:10.2165/11312720-000000000-00000. PMID 19803540.
- Cohen JT, Neumann PJ, Weinstein MC; Neumann; Weinstein (February 7, 2008). "Does prevention care save money? Health economics and the presidential candidates". New England Journal of Medicine 358 (7): 661–663. doi:10.1056/NEJMp0708558. PMID 18272889.
- Neumann PJ, Jacobson PD, Palmer JA; Jacobson; Palmer (Dec 2008). "Measuring the value of public health systems: The disconnect between health economists and public health practitioners". American Journal of Public Health 98 (12): 2173–2180. doi:10.2105/AJPH.2007.127134. PMC 2636521. PMID 18923123.
- Otero HJ, Rybicki FJ, Greenberg D, Neumann PJ; Rybicki; Greenberg; Neumann (Dec 2008). "20 years of cost-effectiveness analysis in medical imaging: Are we improving?". Radiology 249 (3): 917–925. doi:10.1148/radiol.2493080237. PMC 2691813. PMID 19011188.
- Valuing Children's Health: A Comparison of Cost-Utility Analyses for Adult and Paediatric Health Interventions in the US
- Brauer CA, Neumann PJ, Rosen AB; Neumann; Rosen (April 2007). "Trends in cost effectiveness analyses in orthopaedic surgery". Clin. Orthop. Relat. Res. 457: 42–8. doi:10.1097/BLO.0b013e31803372c9. PMID 17242614.
- Cohen JT, Neumann PJ, Weinstein MC; Neumann; Weinstein (February 2008). "Does preventive care save money? Health economics and the presidential candidates". N Engl J Med. 358 (7): 661–3. doi:10.1056/NEJMp0708558. PMID 18272889.
- Bell CM, Urbach DR, Ray JG; Urbach; Ray; Bayoumi; Rosen; Greenberg; Neumann; et al. (March 2006). "Bias in published cost effectiveness studies: systematic review". BMJ 332 (7543): 699–703. doi:10.1136/bmj.38737.607558.80. PMC 1410902. PMID 16495332.
- Brauer CA, Rosen AB, Greenberg D, Neumann PJ; Rosen; Greenberg; Neumann (2006). "Trends in the measurement of health utilities in published cost-utility analyses". Value Health 9 (4): 213–8. doi:10.1111/j.1524-4733.2006.00116.x. PMID 16903990.
- Hahn RW, Kosec K, Neumann PJ, Wallsten S; Kosec; Neumann; Wallsten (June 2006). "What affects the quality of economic analysis for life-saving investments?". Risk Anal. 26 (3): 641–55. doi:10.1111/j.1539-6924.2006.00774.x. PMID 16834624.
- Neumann PJ, Lin PJ, Greenberg D; Lin; Greenberg; Berger; Teutsch; Mansley; Weinstein; Rosen; et al. (January 2006). "Do drug formulary policies reflect evidence of value?". Am J Manag Care 12 (1): 30–6. PMID 16402886.
- Talmor D, Shapiro N, Greenberg D, Stone PW, Neumann PJ; Shapiro; Greenberg; Stone; Neumann (November 2006). "When is critical care medicine cost-effective? A systematic review of the cost-effectiveness literature". Crit Care Med. 34 (11): 2738–47. doi:10.1097/01.CCM.0000241159.18620.AB. PMID 16957636.
- Neumann PJ, Greenberg D, Olchanski NV, Stone PW, Rosen AB; Greenberg; Olchanski; Stone; Rosen (2005). "Growth and quality of the cost-utility literature, 1976-2001". Value Health 8 (1): 3–9. doi:10.1111/j.1524-4733.2005.04010.x. PMID 15841889.
- Neumann PJ, Rosen AB, Weinstein MC; Rosen; Weinstein (October 2005). "Medicare and cost-effectiveness analysis". N Engl J Med. 353 (14): 1516–22. doi:10.1056/NEJMsb050564. PMID 16207857.
- "Health Economics Information Resources: A Self-Study Course". National Library of Medicine. Retrieved 2008-12-05.
- "Health Economics Core Library Recommendations, 2003". National Library of Medicine. Retrieved 2008-12-05.
- Chapman RH, Stone PW, Sandberg EA, Bell C, Neumann PJ; Stone; Sandberg; Bell; Neumann (2000). "A comprehensive league table of cost-utility ratios and a sub-table of "panel-worthy" studies". Med Decis Making 20 (4): 451–67. doi:10.1177/0272989X0002000409. PMID 11059478.