The State of Cost-Utility Analyses in Asia: A Systematic Review

To review and evaluate published cost-utility analyses (CUAs) targeting populations in Asia.

We examined data from the Tufts Medical Center Cost-Effectiveness Analysis Registry, which contains detailed information on more than 3700 English-language CUAs in peer-reviewed journals through 2012. We focused on CUAs pertaining to Asian countries (Asian CUAs), summarized study features and methodological practices, and compared them with CUAs focusing on non-Asian countries (non-Asian CUAs) from 2000 to 2012.

We identified 175 published CUAs pertaining to Asian populations (representing 5.1% of all CUAs) from 2000 to 2012. The number has increased from 19 CUAs in the period 2000 to 2004 to 107 CUAs in the period 2009 to 2012. Roughly one-third focused on Japan (33.1%), followed by Taiwan (15.4%), China (14.9%), and Thailand (8.0%). The diseases targeted in Asian CUAs were cancer (24.6%), infectious diseases (13.7%), cardiovascular diseases (8.6%), and musculoskeletal and rheumatological diseases (5.7%). More Asian CUAs evaluated primary prevention interventions (e.g., vaccinations and screenings) compared with non-Asian CUAs (21.7% vs. 16.5%, P = 0.069). Compared with non-Asian CUAs, significantly more studies in Asia suggest that the health interventions examined provide reasonable value for money. Asian and non-Asian CUAs did not differ in adherence to good methodological practices, including clearly stating the perspective, discounting costs and quality-adjusted life-years, stating a time horizon, and correctly conducting incremental cost-effectiveness analysis. Asian CUAs, however, lagged in reporting sensitivity analyses, disclosing funding status, and currency year.

The number of CUAs in Asia has grown steadily, with more than half focused on pharmaceuticals. The literature reveals that CUAs generally follow good methodological practices though areas for improvement exist.