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Related Experiment Videos

Bias in published cost effectiveness studies: systematic review.

Chaim M Bell1, David R Urbach, Joel G Ray

  • 1St Michael's Hospital, Toronto, Ontario, Canada M5B 1W8. bellc@smh.toronto.on.ca

BMJ (Clinical Research Ed.)
|February 24, 2006
PubMed
Summary

Published studies often report favorable cost-effectiveness ratios, particularly those funded by industry. Higher quality studies and those conducted in Europe and the US were less likely to report these favorable results.

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Area of Science:

  • Health Economics
  • Pharmacoeconomics
  • Health Technology Assessment

Background:

  • Cost-effectiveness analysis is crucial for healthcare decision-making.
  • Published studies often report incremental cost-effectiveness ratios (ICERs) to guide resource allocation.
  • Understanding factors influencing reported ICERs is essential for interpreting research findings.

Purpose of the Study:

  • To determine if published studies predominantly report favorable cost-effectiveness ratios (below $20,000, $50,000, and $100,000 per quality-adjusted life year gained).
  • To identify study characteristics associated with the reporting of favorable cost-effectiveness ratios.
  • To evaluate potential biases in the publication of cost-effectiveness data.

Main Methods:

  • A systematic review of 494 English-language studies published up to December 2001.

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  • Inclusion of studies measuring health effects in quality-adjusted life years (QALYs).
  • Analysis of incremental cost-effectiveness ratios (ICERs) in dollars, adjusted for the year of publication.

    • Main Results:

    • Approximately half (712/1433) of reported ICERs were below $20,000/QALY.
    • Industry-funded studies showed a higher likelihood of reporting favorable ICERs across all thresholds ($20,000, $50,000, $100,000/QALY).
    • Higher methodological quality studies and those conducted in Europe and the US were less likely to report ICERs below $20,000/QALY.

    Conclusions:

    • The majority of published cost-effectiveness analyses report favorable incremental cost-effectiveness ratios.
    • Industry funding is associated with a greater likelihood of reporting favorable cost-effectiveness ratios.
    • Higher study quality and geographical location (Europe, US) correlate with a lower likelihood of reporting favorable cost-effectiveness ratios below $20,000/QALY.