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Can We Better Prioritize Resources for Cost-Utility Research?

Harvard School of Public Health, Boston, MA, pneumann{at}hsph.harvard.edu

Allison B. Rosen, MD, ScD

Harvard School of Public Health, Boston, MA, University of Michigan School of Medicine

Dan Greenberg, PhD

Harvard Medical School, Boston, MA

Natalia V. Olchanski, MS

Harvard School of Public Health, Boston, MA

Richa Pande, MD, MPH

Harvard School of Public Health, Boston, MA

Richard H. Chapman, PhD

Harvard School of Public Health, Boston, MA

Patricia W. Stone, PhD

Columbia University, School of Nursing, New York, NY

Silvia Ondategui-Parra, MD, MPH, MSc

Harvard School of Public Health, Boston, MA

John Nadai, MD

Harvard School of Public Health, Boston, MA

Joanna E. Siegel, ScD

U.S. Agency for Health Care Research and Quality, Rockville, MD

Milton C. Weinstein, PhD

Harvard School of Public Health, Boston, MA

Purpose. We examined 512 published cost-utility analyses (CUAs) in the U.S. and other developed countries from 1976 through 2001 to determine: 1) the types of interventions studied; 2) whether they cover diseases and conditions with the highest burden; and, 3) to what extent they have covered leading health concerns defined by the Healthy People 2010 report. Data and Methods. We compared rankings of the most common diseases covered by the CUAs to rankings of U.S. disease burden. We also examined the extent to which CUAs covered key Healthy People 2010 priorites. Results.CUAs have focused mostly on pharmaceuticals (40%) and surgical procedures (16%). When compared to leading causes of DALYs, the data show overrepresentation of CUAs in cerebrovascular disease, diabetes, breast cancer, and HIV/AIDS, and underrepresentation in depression and bipolar disorder, injuries, and substance abuse disorders. Few CUAs have targeted Healthy People 2010 areas, such as physical activity. Conclusions. Published CUAs are associated with burden measures, but have not covered certain important health problems. These discrepancies do not alone indicate that society has been targeting resources for research inefficiently, but they do suggest the need to formalize the question of where each CUA research dollar might do the most good.

Key Words: Cost-effectiveness analysis • cost-utility analysis • burden of disease • disability-adjusted life years

Medical Decision Making, Vol. 25, No. 4, 429-436 (2005)
DOI: 10.1177/0272989X05276853


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