The Biggest Research Questions the CEA Registry Helped Answer in 2022
We compiled our favorite publications from 2022 that were supported by data from the CEA Registry. The following list represents a breadth of important questions germane to the practice and application of cost-effectiveness analysis.
1. What is the relationship between costs and health benefits of branded pharmaceuticals?
This paper reported a significant relationship between benefits and drug costs. The authors estimated that one additional quality-adjusted life-year (QALY) is associated with a $28,561 increase in incremental costs, which falls within common willingness-to-pay benchmarks (e.g., $50,000 per QALY gained). Nevertheless, there remains a substantial amount of unexplained variation in pharmaceutical costs.
Read the full paper: Frech HE, Pauly MV, Comanor WS, Martinez JR. Costs and Benefits of Branded Drugs: Insights from Cost-Effectiveness Research. Journal of Benefit-Cost Analysis. 2022;13(2):166-81.
2. Are the recommended equal discount rates for cost and health outcomes consistent with trends in the CEA literature?
Between 1995 and 2018, the average nominal and inflation-adjusted cost-effectiveness thresholds increased. Assuming a 3% annual discount rate for costs, the authors estimated that the discount rate for health would need to equal about 2.4% to be consistent with observed trends in author-reported cost-effectiveness thresholds.
3. Is industry sponsorship of Cost-Effectiveness Analyses (CEAs) associated with favorable findings?
This analysis found industry sponsored CEAs to be over 3 times more likely than non-industry sponsored studies to publish incremental cost-effectiveness ratios (ICERs) below $150,000 per QALY gained. ICERs from industry sponsored studies were estimated to be 33% more favorable than ICERs from non-industry sponsored studies.
Read the full paper: Xie F, Zhou T. Industry sponsorship bias in cost effectiveness analysis: registry based analysis. bmj. 2022 Jun 22;377.
4. What is the cost-effectiveness of rotavirus vaccination in children under five in 195 countries?
Globally, the median ICER of rotavirus vaccination was estimated to be $2,289. Estimates vary by country, due to differences in vaccine efficacy, cost, GDP per capita, and disability-adjusted life-years attributable to rotavirus. ICERs ranged from $85 per DALY averted in Central African Republic to $70,599 per DALY averted in the United States.
5. How much value do patients (versus manufacturers) capture from drugs and other health care interventions?
According to study investigators, a large share of the value of medical innovation accrues to patients. At a median ICER of $27,000, if patients value a QALY at $450,000, manufacturers capture an estimated 6% of the value of drugs. If patients value a QALY at $150,000, the median share appropriated for drugs is around 18%.
Read the full paper: Hult KJ, Philipson TJ. The Value of Medical Innovation Versus Industry Rewards. Value Health. 2022 Dec 8:S1098-3015(22)04752-0.
6. Are Medical Care Prices Still Declining?
In an analysis of approximately 11,000 cost-effectiveness estimates from the CEA Registry, the authors found that quality-adjusted prices (i.e., prices that account for changes in health outcomes from medical innovations) declined by 1.33 percent per year from 2000 to 2017. This finding contrasts with official statistics which suggest medical care prices increased by 0.53 percent per year relative to economy-wide inflation.
Read the full paper: Dunn A, Hall A, Dauda S. Are Medical Care Prices Still Declining? A Re‐Examination Based on Cost‐Effectiveness Studies. Econometrica. 2022 Mar;90(2):859-86.
7. How does the inclusion of societal costs in economic evaluations of multiple sclerosis-related interventions influence the results?
The inclusion of societal costs, such as productivity losses and/or informal care costs, led to a change in conclusions about the cost-effectiveness of an intervention in 15% of the economic evaluations that were reviewed. In 60% of these cases, the results became more favorable from a societal perspective (versus a healthcare payer’s perspective), while the results became less favorable in the remaining 40%.
8. Can a catalogue of health state utility values support economic modeling in sickle cell disease?
The authors identified empirically elicited health state utility values associated with general sickle cell disease (n=1), its complications (n=2), and its treatments (n=3). No study measured health state utilities of caregivers, despite the condition’s significant health-related quality of life impact on these individuals.
9. Can a linear constrained optimization approach support the development of a health benefits package in Uganda?
This study suggested that a constrained optimization approach may facilitate the design of health benefits packages. After accounting for financial and physical resource constraints faced by Uganda’s public health sector, the analysis generated a health benefits package that consisted of 58 interventions and averted 49.9 million net DALYs.
10. What are the net benefits of personalized medicine?
The median incremental QALYs, costs, and net monetary benefits per individual of personalized medicine were estimated to be 0.03, $575, and $18, respectively. The authors concluded that the health benefits of personalized medicine may be counterbalanced by their higher costs.
