Can we better prioritize resources for cost-utility research?
OBJECTIVE
We examined 512 published cost-utility analyses (CUAs) in the U.S. and other developed countries from 1976 through 2001 to determine: 1) the types of interventions studied; 2) whether they cover diseases and conditions with the highest burden; and, 3) to what extent they have covered leading health concerns defined by the Healthy People 2010 report.


METHODS
We compared rankings of the most common diseases covered by the CUAs to rankings of U.S. disease burden. We also examined the extent to which CUAs covered key Healthy People 2010 priorities.


RESULTS
CUAs have focused mostly on pharmaceuticals (40%) and surgical procedures (16%). When compared to leading causes of DALYs, the data show overrepresentation of CUAs in cerebrovascular disease, diabetes, breast cancer, and HIV/AIDS, and underrepresentation in depression and bipolar disorder, injuries, and substance abuse disorders. Few CUAs have targeted Healthy People 2010 areas, such as physical activity.


CONCLUSIONS
Published CUAs are associated with burden measures, but have not covered certain important health problems. These discrepancies do not alone indicate that society has been targeting resources for research inefficiently, but they do suggest the need to formalize the question of where each CUA research dollar might do the most good.
Neumann
Peter J
PJ
Harvard School of Public Health, Boston, MA 02115, USA. pneumann@hsph.harvard.edu.
Rosen
Allison B
AB
Greenberg
Dan
D
Olchanski
Natalia V
NV
Pande
Richa
R
Chapman
Richard H
RH
Stone
Patricia W
PW
Ondategui-Parra
Silvia
S
Nadai
John
J
Siegel
Joanna E
JE
Weinstein
Milton C
MC
D003362:Cost-Benefit Analysis; D006233:Persons with Disabilities; D017048:Health Care Costs; D006302:Health Services Research / Q000191:economics*; D006801:Humans; D019057:Quality-Adjusted Life Years; D040841:Resource Allocation