Please click on question to review explanation.
1. Why is a specific paper not in the Registry?
The paper may not satisfy our inclusion criteria: 1) published in English; 2) is an original cost-effectiveness analysis; and 3) measures health benefits as QALYs. If you believe a paper satisfies these criteria and should be considered, please let us know.
2. When will new data be posted?
Data for 2015 is now available and updates for 2016 data are ongoing. The CEA Registry team posts newly collected data three times per year.
3. What is the difference between CEA and CUA?
Both cost-effectiveness analyses (CEAs) and cost-utility analyses (CUAs) describe an intervention’s impact in terms of its incremental costs divided by its incremental health benefits. Cost-utility analyses quantify health benefits in terms of gained quality adjusted life years (QALYs), relative to a comparator. For example, if an intervention increases health care costs by $1 million and gains 20 QALYs in a population, its cost-utility ratio is $50,000 per QALY.
A CEA also reports the impact of an intervention relative to a comparator in terms of a ratio, but the health benefits can be quantified using a wide variety of units, such as lives saved, life years saved, cases of disease prevented, or additional symptom-free days. For example, an intervention that increases health care costs by $1 million and prevents 100 cases of cancer would have a cost-effectiveness ratio of $10,000 per cancer case prevented.
4. Are you going to include non-medical CUAs?
The Registry includes all CUAs indexed in Medline. There are a limited number of non-medical CUAs such as diet, injury prevention, and environmental remediation.
5. Can you conduct additional analysis of the data for me?
Our Center provides fee-based analysis of the CEA Registry data. Financial terms will be determined on a case-by-case basis, depending on the scope and detail of analysis required. Please contact Teja Thorat for more information.
6. What is the acceptable cost/QALY threshold?
While this is a much discussed topic, there is no universal cost/QALY threshold (see references below). In the US, $50,000/QALY is frequently cited as an acceptable cost/QALY. However, most commentators acknowledge that in the real world, most health care innovations that cost less than $100,000/QALY, and frequently those with higher cost/QALY ratios are adopted. A recent paper by Braithwaite et al. estimated the cost-effectiveness of health expenditures in the U.S. in 2003 compared to 1950 as between $109,000 to $297,000 per QALY. In the UK, the National Institute for Clinical Excellence (NICE) does not have "hard" decision rules, but new medical technologies with ICERs between £20,000-30,000/QALY are typically accepted. (Click Reference for more detail.)
- Devlin, Nancy, Parkin, David. Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis. Health Economics 2004;13(5):437-452.
- Hirth, RA, Chernew ME, Miller, E, Fendrick AM, Weissert WG. Willingness to pay for a quality-adjusted life year: In search of a standard. Medical Decision Making 2000;20:332-342.
- Neumann, PJ. Using cost-effectiveness analysis to improve health care: Opportunities and barriers. Oxford University Press: Oxford, 2005, pp.157-158.
- Weinstein MC. How much are Americans willing to pay for a quality-adjusted life year? Med Care. 2008 Apr; 46(4):349-56.
- Braithwaite RS, Meltzer DO, King JT Jr, Leslie D, Roberts MS. What Does the Value of Modern Medicine Say About the $50,000 per Quality-Adjusted Life-Year Decision Rule? Med Care. 2008 Apr; 46(4):343-5.
7. What types of interventions are most common in the Registry?
|Intervention ||Number ||% |
|Pharmaceutical ||2496 ||44% |
|Surgical ||747 ||13% |
|Medical Procedure ||669 ||12% |
|Care Delivery ||618 ||11% |
|Screening ||660 ||12% |
|Medical Device ||415 ||7% |
|Health Education ||530 ||9% |
|Diagnostic ||411 ||7% |
|Immunization ||359 ||6% |
|Other ||309 ||6% |
|(Based on Data 1976 to 2015) || || |
8. Which countries are best represented by the CUAs in the Registry?
|Country ||Number ||% |
|United States ||2088 ||37% |
|United Kingdom ||1088 ||19% |
|Canada ||423 ||8% |
|Netherlands ||395 ||7% |
|Sweden ||230 ||4% |
|Australia ||153 ||3% |
|Other ||1566 ||28% |
|(Based on Data from 1976 to 2015) || || |
9. Are the data available as a downloadable file?
Our sponsors have access to the most updated and comprehensive CEA Registry data and can access data through a password protected site where they can download the data in excel. For more information, please see Sponsorship.
10. How should we cite the CEA Registry?
Center for the Evaluation of Value and Risk in Health. The Cost-Effectiveness Analysis Registry [Internet]. (Boston), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center. Available from: www.cearegistry.org Accessed on [Date].
11. How are utility weights adjusted for comorbid conditions?
There are a number of ways that utilities for comorbid conditions are reported in the cost-effectiveness literature. The CEA registry does not take a position on which method is most appropriate. If the utility comes from a patient population using a multi-attribute quality of life instrument, then any health state the patient is experiencing is included in the weight. In some cases, authors may not adjust at all for comorbid conditions. Authors may also multiply the weights from the two health states together. Authors may apply the disutility of a comorbid condition to the first condition to arrive at a utility weight for the comorbid conditions. In the registry, we have reported the weights as the author has reported them, except when weights were presented as disutilities. If weights were reported as disutilities, we subtracted the absolute value from 1. E.g. The weight for diabetes was reported as 0.67 and the disutility for MI was reported as -0.15, then the registry would report the weight for MI in this paper as 0.85 (1-0.15), not 0.52. In all cases, before using a utility weight, refer to the article for details on how the authors used and adjusted utility weights.
12. Can we conduct an advanced search of the CEA Registry?
CEA Registry sponsors and subscribers can conduct advanced searches through a password protected site. As examples of the functions available to advanced search, sponsors and subscribers can search for analyses by ICD-9 codes, year of publication, country applicable, etc. For information on becoming a sponsor or subscriber, visit our Premium Access page.
13. How can I become a reader for the CEA Registry?
The registry’s contents are collected by our reviewers, who carefully audit and collect information from published cost-effectiveness articles. Given the increasing popularity of CEAs, we need more reviewers to keep the database up to date. If you would like to join this project, there are two options: the summer intensive reading program and our regular reading program.
*Regular reading: Regular readers read from 6 to 12 articles every 4 weeks, as mutually agreed upon by the reader and the coordinator. Reviewers participate remotely.
*Summer intensive reading: The summer intensive reading lasts 8-weeks during the summer. Intensive reviewers read 30 articles during each two-week reading period, 120 articles over the entire eight-week summer. Office space is available at Tufts Medical Center for reviewers, or you may participate remotely. Applications are no longer accepted for 2015 internship. We will post on this page when we are accepting 2016 internship applications.
Each reviewer individually reviews articles and fills out audit forms. To ensure data reliability and validity, each article is reviewed by two readers. The two readers for each article discuss the information they have collected and achieve a consensus. The consensus meeting may occur in person or by phone.
Reviewers should have taken cost-effectiveness-related graduate-level coursework, be familiar with cost-effectiveness analysis techniques, have good communication and critical reading skills, and work in a timely manner.
Each reader is compensated $25 per on time, acceptable*, completed article. Each article takes approximately one hour, though review times vary by reviewers or complexity of article. For Non-U.S. citizens, the valid visa status is required. Volunteers are also welcome.
(*Note: Readers may judge some articles as ineligible for inclusion in the Registry)
Interested applicants should email a current CV to Teja Thorat. Please indicate if you are interested in participating as a “regular reviewer” or as a “summer intensive reviewer.”