Cost-utility analyses of clinical preventive services - Published ratios, 1976-1997

Background: Cost-effectiveness analyses of clinical preventive services are a potential means to aid public health resource allocation. Cost-utility a nalysis (CUA) is a specific form of cost-effectiveness analysis where resul ts are expressed in terms of cost per quality-adjusted life year (QALY) gai ned. To increase the transparency and comparability of CUAs, standardizatio n of methods has been recommended. Objectives: The purposes of this study were as follows: (1) identify publis hed articles with original CUAs of primary and secondary clinical preventiv e services, (2) summarize the ratios found in these analyses, (3) identify articles employing comparable methods, and (4) explore analytic methods emp loyed over time. Methods: As part of a larger study we conducted a comprehensive search of p ublished CUAs in the area of clinical preventive services and systematicall y collected data on the results of the analyses and analytic methods employ ed. Cost-effectiveness ratios were standardized and organized into a table. Results: We found 50 CUAs pertaining to clinical preventive services (prima ry, n=22, 44%; and secondary, n=28, 56%) and 174 cost-effectiveness ratios. These ratios ranged from cost-savings up to $27,000,000/QALY, with a media n of $14,000/QALY. Only three (6%) of the CUAs met minimum reference case r equirements. There was no apparent improvement of methods over time. Conclusions: Immunizations and chemoprophylaxis have the most favorable cos t-effectiveness ratios, and preventive services are more cost-effective whe n targeted at high-risk populations. However, there is wide variation in th e methods used in these analyses. This study allows us to define where impr ovements in methodologic rigor need to occur, provides a base-line for futu re audits, and highlights disease areas in clinical preventive services tha t have been omitted or underevaluated. (C) 2000 American Journal of Preventive Medicine.