Health outcome measures used in cost-effectiveness studies: a review of original articles published between 1986 and...

Theoretically, the preferred type of health economic evaluation is the cost-benefit approach in which costs as well as benefits are measured in monetary units. This type of analysis is rarely found in practice, however, where cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and other forms of economic evaluations are instead favored. The use of quality adjusted life-years (QALYs) or life-years gained, if applicable, is generally recommended in CUA/CEA because these measures will make possible broad comparisons with other studies as well as with norms regarding society's willingness-to-pay for health benefits. The purpose of this paper is to study the choice of health outcome measures and the extent to which results from CUA and CEA are discussed from such a willingness-to-pay perspective. Based on the analysis of a sample of 455 studies included in the Health Economic Evaluations Database (HEED), it is concluded that major differences exist in the choice of health outcome measures across disease categories. There is no evidence that QALYs or life-years gained have become more common over the years and CEAs using intermediary outcome measures are as common as those using life-years gained. Furthermore, studies using QALYs or life-years gained often lack a relevant discussion of society's willingness-to-pay per QALY or life-years gained.