title: The changing face of the cost-utility literature, 1990-2012.
abstract: OBJECTIVE
  Cost-utility analyses (CUAs) have been published widely over the years to measure the value of health care interventions. We investigated the growth and characteristics of CUAs in the peer-reviewed English-language literature through 2012.
  
  
  METHODS
  We analyzed data from the Tufts Medical Center Cost-Effectiveness Analysis (CEA) Registry, a database containing more than 3700 English-language CUAs published through 2012. We summarized various study characteristics (e.g., intervention type, funding source, and journal of publication) and methodological practices (e.g., use of probabilistic sensitivity analysis) over three time periods: 1990 to 1999, 2000 to 2009, and 2010 to 2012. We also examined CUAs by country, region, and the degree to which diseases studied correlate with disease burden.
  
  
  RESULTS
  The number of published CUAs rose from 34 per year from 1990 to 1999 to 431 per year from 2010 to 2012. The proportion of studies focused on the United States declined from 61% during 1990 to 1999 to 35% during 2010 to 2012 (P < 0.0001). Although still small compared with CUAs in higher income countries, the number of CUAs focused on lower and middle-income countries has risen sharply. A large fraction of studies pertain to pharmaceuticals (46% during 2010-2012). In recent years, most studies included probabilistic sensitivity analysis (67% during 2010-2012). Journals publishing CUAs vary widely in the percentage of their studies funded by drug companies. Some conditions, such as injuries, have high burden but few CUAs.
  
  
  CONCLUSIONS
  Our review reveals considerable growth and some change in the cost-utility literature in recent years. The data suggest growing interest in cost-utility methodology, particularly in non-Western countries.
authors.affiliation: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA. Electronic address: pneumann@tuftsmedicalcenter.org.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Neumann
authors.affiliation: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.
authors.forename: Teja
authors.initials: T
authors.lastname: Thorat
authors.affiliation: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Shi
authors.affiliation: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.
authors.forename: Cayla J
authors.initials: CJ
authors.lastname: Saret
authors.affiliation: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Cohen
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods / Q000639:trends*; D016208:Databases, Factual / Q000639:trends*; D006801:Humans; D019057:Quality-Adjusted Life Years; D012042:Registries
keywords: cost-effectiveness analysis; cost-utility analysis; quality-adjusted life-year; review