- Cost-Effectiveness Analysis Registry
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 2,700 cost-utility analyses published through 2010. 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 2010, including information on more than 7000 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.
Ratio Quadrant less effective more effective more costly 1 2 less costly 3 4
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
- Kamae MS, Kamae I, Cohen JT, Neumann PJ. (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. PMID 21332273.
- Greenberg, D and Neumann, PJ. "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. PMID 21351863.
- Braithwaite RS and 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 (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. PMID 20446040.
- Chambers JD, Neumann PJ, Buxton MJ (Jul-Aug 2010). "Does Medicare Have an Implicit Cost-Effectiveness Threshold?". Medical Decision Making 30 (4): E14-27. PMID 20551473.
- Meckley LM, Greenberg D, Cohen JT, Neumann PJ (2010). "The adoption of cost-effectiveness acceptability curves in cost-utility analyses". Medical Decision Making 30 (3): 314–9. PMID 19773582.
- Neumann PJ, Auerbach HR, Cohen JT, Greenberg D (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 (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. PMID 20228286.
- Greenberg D, Earle CC, Fang CH, Eldar-Lissai A, Neumann PJ (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. PMID 20056956.
- Nelson AL, Cohen JT, Greenberg D, Kent DM (Nov 2009). "Much cheaper, almost as good: Decrementally cost-effective medical innovation". Annals of Internal Medicine 151 (9): 662–667. PMID 19884627.
- Rosen AB, Spaulding A, Greenberg D, Palmer JA, Neumann PJ (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. PMID 19536023.
- Neumann PJ, Fang CH, Cohen JT (2009). "30 years of pharmaceutical cost-utility analyses: growth, diversity, and methodological improvement". Pharmacoeconomics 27 (10): 861–872. PMID 19803540.
- Cohen JT, Neumann PJ, Weinstein MC (February 7, 2008). "Does prevention care save money? Health economics and the presidential candidates". New England Journal of Medicine (358): 661–663. doi:10.1056/NEJMp0708558. PMID 18272889.
- Neumann PJ, Jacobson PD, Palmer JA (Dec 2008). "Measuring the value of public health systems: The disconnect between health economists and public health practioners". American Journal of Public Health 98 (12): 2173–2180. doi:10.2105/AJPH.2007.127134. PMC 2636521. PMID 18923123. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2636521.
- Otero HJ, Rybicki FJ, Greenberg D, Neumann PJ (Dec 2008). "20 years of cost-effectiveness analysis in medical imaging: Are we improving?". Radiology 249 (3): 917–925. 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 (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 (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. http://content.nejm.org/cgi/content/full/358/7/661.
- Bell CM, Urbach DR, Ray JG, 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. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1410902.
- Brauer CA, Rosen AB, Greenberg D, Neumann PJ (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 (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, et al. (January 2006). "Do drug formulary policies reflect evidence of value?". Am J Manag Care 12 (1): 30–6. PMID 16402886. http://www.ajmc.com/pubMed.cfm?pii=3073. [dead link]
- Talmor D, Shapiro N, Greenberg D, Stone PW, Neumann PJ (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 (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. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1098-3015&date=2005&volume=8&issue=1&spage=3.
- Neumann PJ, Rosen AB, Weinstein MC (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. http://www.nlm.nih.gov/nichsr/edu/healthecon/glossary.html. Retrieved 2008-12-05.
- ^ "Health Economics Core Library Recommendations, 2003". National Library of Medicine. http://www.nlm.nih.gov/nichsr/corelib/hecon.html. Retrieved 2008-12-05.
- ^ a b Chapman RH, Stone PW, Sandberg EA, Bell C, Neumann PJ (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. http://mdm.sagepub.com/cgi/content/abstract/20/4/451.
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