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 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.

General information

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.

Article Information

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).

Ratio Information

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

• 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.
• Valuing Children's Health: A Comparison of Cost-Utility Analyses for Adult and Paediatric Health Interventions in the US

External links

• Official website
• Center for the Evaluation of Value and Risk in Health
• Institute for Clinical Research and Health Policy Studies
• MedlinePlus Health Information
• National Library of Medicine
• Health Economics Information Resources
• The Politics of Prevention