ABSTRACT
The field of cost-effectiveness analysis (CEA) has grown rapidly but in somewhat lopsided fashion. The number of published cost-per-quality-adjusted life year (QALY) analyses increased from an average of 34 per year from 1990 to 1999, to 484 per year from 2010 to 2014, to 856 per year from 2016 to 2020. However, the analyses have disproportionately focused on prescription drugs, with relatively less attention to health services and procedures. Despite the fact that pharmaceuticals comprise roughly 15 percent of health spending (estimates depend on how the fraction is calculated and range from 10 to 20 percent), 43 percent of CEAs published since 1976 have focused on pharmaceuticals, according to analyses of the Tufts Medical Center’s CEA Registry. While the bulk of health spending comprises services and procedures delivered in hospitals, clinics, and physician offices, only 12 percent of studies have focused on care delivery interventions and 26 percent on medical and surgical procedures. Moreover, the proportion of CEAs devoted to pharmaceuticals has remained steady over time.