User:CEA Registry/Sandbox

The Cost-Effectiveness Analysis (CEA) 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 1,100 cost-utility analyses published through 2005 (2006 data will be posted in December 2008). 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 2005, including information on more than 3000 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 quality-adjusted life years (QALYs). The QALY is 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: 1) the type of intervention evaluated; 2) the country of the analysis; 3) the funding source. For methodology, the registry reports 1) whether the article correctly calculated incremental cost-utility ratios; 2) the analytic time horizon and analytic perspective (e.g., societal or health care payer); 3) what discount rate, if any was used; 3) the currency used; 4) whether the analysis accounted for additional costs associated with greater longevity achieved through treatment; 5) the type of sensitivity or uncertainty analysis used; 6) whether the article specified a threshold for identifying acceptably favorable cost-effectiveness ratios; and 7) 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 (1= more costly, less effective, 2= more costly, more effective; 3= less costly, less effective, and 4= less costly, more effective).

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

Trends in cost effectiveness analyses in orthopaedic surgery

[http://content.nejm.org/cgi/content/full/358/7/661 Does preventive care save money? Health economics and the presidential candidates]

Bias in published cost effectiveness studies: systematic review

Trends in the measurement of health utilities in published cost-utility analyses

What affects the quality of economic analysis for life-saving investments?

Do drug formulary policies reflect evidence of value?

[http://www.ncbi.nlm.nih.gov/pubmed/16957636?dopt=Abstract When is critical care medicine cost-effective? A systematic review of the cost-effectiveness literature]

Growth and quality of the cost-utility literature, 1976-2001

Medicare and cost-effectiveness analysis