title: Systematic overview of cost-utility assessments in oncology.
abstract: OBJECTIVE
  Cost-utility analyses (CUAs) present the value of an intervention as the ratio of its incremental cost divided by its incremental survival benefit, with survival weighted by utilities to produce quality-adjusted life years (QALYs). We critically reviewed the CUA literature and its role in informing clinical oncology practice, research priorities, and policy.
  
  
  METHODS
  The English-language literature was searched between 1975 and1997 for CUAs. Two readers abstracted from each article descriptions of the clinical situation and patients, the methods used, study perspective, the measures of effectiveness, costs included, discounting, and whether sensitivity analyses were performed. The readers then made subjective quality assessments. We also extracted utility values from the reviewed papers, along with information on how and from whom utilities were measured.
  
  
  RESULTS
  Our search yielded 40 studies, which described 263 health states and presented 89 cost-utility ratios. Both the number and quality of studies increased over time. However, many studies are at variance with current standards. Only 20% of studies took a societal perspective, more than a third failed to discount both the costs and QALYs, and utilities were often simply estimates from the investigators or other physicians.
  
  
  CONCLUSIONS
  The cost-utility literature in oncology is not large but is rapidly expanding. There remains much room for improvement in the methodological rigor with which utilities are measured. Considering quality-of-life effects by incorporating utilities into economic studies is particularly important in oncology, where many therapies obtain modest improvements in response or survival at the expense of nontrivial toxicity.
authors.affiliation: Center for Outcomes and Policy Research, Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. craig_earle@dfci.harvard.edu
authors.forename: C C
authors.initials: CC
authors.lastname: Earle
authors.forename: R H
authors.initials: RH
authors.lastname: Chapman
authors.forename: C S
authors.initials: CS
authors.lastname: Baker
authors.forename: C M
authors.initials: CM
authors.lastname: Bell
authors.forename: P W
authors.initials: PW
authors.lastname: Stone
authors.forename: E A
authors.initials: EA
authors.lastname: Sandberg
authors.forename: P J
authors.initials: PJ
authors.lastname: Neumann
mesh_terms: D002986:Clinical Trials as Topic / Q000191:economics; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000592:standards; D006801:Humans; D008495:Medical Oncology / Q000191:economics* / Q000706:statistics & numerical data; D009369:Neoplasms / Q000191:economics*; D011642:Publications