Health Economics

A Comprehensive League Table of

Cost-Utility Ratios and a Sub-table of
"Panel-worthy" Studies
RICHARD H. CHAPMAN, MS, PATRICIA W. STONE, RN, MPH, PhD,
EILEEN A. SANDBERG, MS, MBA, CHAIM BELL, MD,
PETER J. NEUMANN, ScD

Objectives. The authors compiled a comprehensive league table of cost/QALY ratios,

and a standardized table of analyses satisfying selected Reference Case criteria from
the USPHS Panel on Cost-Effectiveness in Health and Medicine. Methods. They
identified 228 cost-utility analyses (CUAs) through literature searches, and abstracted
data on methods and cost-utility ratios. The subset of "Panel-worthy" analyses used:
a societal or broad health-care perspective, community or patient preference weights,
net costs, incremental comparisons, and discounting of costs and QALYs. Results.
The 228 CUAs included ratios for 647 interventions, ranging from cost-saving to
$52,000,000/QALY (median $12,000/QALY). The standardized table presents 112
=

ratios that met the "Panel-worthy" criteria, with articles published in recent years more
likely to meet all of the criteria. Conclusions. The comprehensive league table (avail-
able on the Web) provides a useful reference, but ratios may not be comparable be-
cause of methodologic variations. The standardized table focuses on studies meeting
basic methodologic criteria, potentially allowing for better comparison with future Ref-
erence Case analyses. Future studies should investigate the quality of analyses’ un-

derlying assumptions in addition to whether certain key procedural protocols were met.
Key words: cost-utility analysis; league tables; economic evaluation. (Med Decis
Making 2000;20:451-467)

Ranked listings of the cost-effectiveness ratios of not know whether a program is a good value until
various health and medical interventions, often it is compared with the benefits derived from re-
called &dquo;league tables,&dquo; have been used to facilitate sources expended in other programs. These league

comparisons across cost-effectiveness analyses.
Comparisons of ratios are essential because we do
Received October 22, 1999, from the Program on the Eco-
nomic Evaluation of Medical Technology, Harvard Center for
Risk Analysis, Harvard School of Public Health, Boston, Massa-
chusetts (RHC, PWS, EAS, CB, PJN), the University of Rochester
School of Nursing, Community and Preventive Medicine, Roch-
ester, New York (PWS); the Institute of Medical Science, Univer-
sity of Toronto, Toronto, Ontario, Canada (CB), and the Depart-
ment of Health Policy and Management, Harvard School of
Public Health (PJN) Revision accepted for publication March 22,
2000 Presented in part at the annual meeting of the Society for
Medical Decision Making, October 4, 1999, in Reno, Nevada. Sup-
ported entirely by a grant from the National Science Foundation
and Merck & Co., Inc. under the joint NSF/Private Sector Re-
search Opportunity Initiative (SBR-9730448). Mr Chapman was
supported by a training grant from the Agency for Health Care
Policy and Research, and Dr. Bell held a fellowship from the
Medical Research Council of Canada, at the time of this study
Address correspondence and reprint requests to Dr. Neu-
mann. Harvard Center for Risk Analysis, 718 Huntington Avenue,
Boston, MA 02115, telephone (617) 432-1312; fax. (617) 432-0190;
e-mail. ≺pneumann@hsph.harvard edu).
tables (so called after the tables used for British soc-
cer league standings) have often been criticized,
however.1-4 The major criticism is that listing anal-
yses in one table &dquo;implies a certain degree of ho-
mogeneity in study methodology,&dquo; a homogeneity
that is usually missing.2 Drummond and colleagues
list methodologic features that are particularly im-
portant to consider when interpreting rankings
within league tables, including: the discount rate,
utility valuation methods, the included range of
costs and effects, and the choice of comparison pro-
gram. Mason proposed a similar &dquo;minimum data-
set&dquo; that he recommended should be included with
each entry in a cost-effectiveness league table.3 To
reduce the effect of variability in source-study meth-
ods, these authors have recommended that league
tables include only studies that are standardized on
key analytic practices.
While complete standardization of league-table
entries is the ideal, most published analyses do not
allow this. A recent systematic audit of 228 cost-

451
452
Table 1 * Information Collected about Each Article
utility analyses (CUAs) published from 1976 to 1997
revealed wide variations in methods for estimating
and reporting costs, effectiveness, and preference
weights, and little evidence of improvement over
time.5,6 This confirmed earlier findings of variations
in methods for estimating QALYS in CUAs.7Others
have reported that many published cost-effective-
ness analyses do not adhere to commonly accepted
standards.1,8-15 Furthermore, inadequacies of
porting and the space constraints of journal publi-
cation often mean that the methodologic details of
CUAs are not disclosed.55
The purpose of this study was to use data from a
comprehensive review of published CUAs to create
two league tables: 1) a comprehensive listing of in-
terventions and their cost/QALY ratios, and 2) a stan-
dardized sub-table that includes only ratios from
analyses that adhere to key methodologic recom-
mendations of the U.S. Public Health Service
(USPHS) Panel on Cost-Effectiveness in Health and
Medicine. 16,17 The Panel has set out guidelines for
the &dquo;Reference Case&dquo; analysis-an analysis using
standard methodologic practices, intended to in-
re- form resource-allocation decisions across studies.
Methods
Details of the study design, data collection, and
analytic plan are presented below.

SOURCE STUDIES AND DATA COLLECTION
We conducted a computerized literature search
through 1997 of the following databases: Medline,
HealthSTAR, CancerLit, all editions of Current Con-
tents, and EconLit. We searched for the Medical
Subject Headings and/or text key words: &dquo;quality-
adjusted,&dquo; &dquo;QALY,&dquo; and &dquo;cost-utility,&dquo; and identified
approximately 1,500 candidates for the database. We
then screened the titles and abstracts to remove ob-
viously non-eligible articles, such as methodologic,
review, and non-CUA studies. A final list of 228 orig-
inal CUAs published in English from 1976 through
1997 was compiled. A data-collection (or audit) form
was developed, and several versions of the form
were pilot tested before being put into use. The final
version of the form had 69 fields on the reporting
and methods used (table 1), including: study per-
spective ; the measurement of effectiveness, health-
state preferences, and costs; the use of discounting;
and whether incremental analyses were performed.
We used the forms to abstract data from the 228
CUAs, with two readers per article. The data were
abstracted independently; then the two readers met
to reach consensus on discordant items. The ab-
stracted information was recorded in a relational
database (FileMaker Pro, ver. 3.0). Further details of
the data-collection and auditing methods have been
reported elsewhere.s
6
The baseline cost-per-QALY ratios from each ar-
ticle were also recorded in the database. Because
CUAs often compare several possible programs or
intensity levels, a single article could contribute
more than one baseline CU ratio (with one to 18
ratios per article in this database). For example,
while 45% of the studies in the database contained
one ratio each, 5% contributed ten or more ratios.
Ratios were reported as costs per QALY gained, cost-
saving (if the intervention was less costly but pro-
duced more QALYs than its comparator), or domi-
nated (if more costly and less effective). It is also
possible for the evaluated intervention to be both
less costly and less effective than the comparator
program, yielding a CU ratio with negative numbers
in both the numerator and the denominator. This
was true for two of the evaluated interventions in
our database (neither of which is in the &dquo;Panel-
worthy&dquo; subset of articles). Although a single (posi-
tive) ratio can be reported in these cases, the inter-
pretation of these ratios is not the same as when the
intervention is more costly but more effective. Re-
placing the comparator (status quo) program with
this type of intervention would yield a certain
amount of savings per QALY foregone, so a higher
ratio is actually considered more cost-effective than
a lower ratio.18 Because of this different interpreta-
tion, we have added a footnote to the comprehen-
453
sive league table, indicating the two cases where this
occurs.
For each cost-per-QALY ratio, we recorded a brief
description of the evaluated health-care interven-
tion, a description of the baseline comparator, and
the target population for which the intervention is
intended (following a practice begun by Graham and
Vaupel19). We also classified each intervention into
the appropriate disease category (based on the ICD-
9 classification system), intervention type, and level
of prevention (primary, secondary, or treatment).
ADJUSTMENTS TO PUBLISHED
COST-EFFECTIVENESS RATIOS
The CUAs in this database had been conducted in
several different countries and in different years. To
allow comparisons across countries, all non-U.S.
converted
currency figures were into U.S. dollars,
using the foreign exchange factor appropriate to
that country for the base year.2o In addition, the dol-
lar values reported in these studies ranged from
1976 to 1996. Each year’s nominal dollar amounts
were inflated to real 1998 dollars using the general
Consumer Price Index (CPI).21 (Which version of the
CPI to use in adjusting for health care inflation has
been the subject of some debate.2z z3 Some have ar-
gued for using the general rather than the medical
CPI, because of concern over whether the medical
component of the CPI adequately captures changes
in the quality or intensity of medical services over
time.) Finally, all CU ratios were rounded off to two-
digit precision.
DATA ANALYSIS
A comprehensive league table (published on the
Web at (www.hcra.harvard.edu/medical.html)) pre-
sents the cost-per-QALY ratios as reported in the lit-
erature, with each study’s costs inflated to a base
year. We then present several descriptive summary
tables based on the information gathered in the da-
tabase. These tables summarize the studies in the
database, and stratify the information by the type of
intervention, prevention stage, and disease category.
The methods used in each analysis were also
compared with key recommendations in the recent
report of the USPHS Panel on Cost-Effectiveness in
Health and Medicine} 1617 to determine the extent to
which the studies adhered to standard practices and
whether there is any evidence that methods have
been improving over time.
A second league table (presented in the appendix
and also posted on the Web at (www.hcra.harvard.
edu/medical.html)) includes only ratios from those
studies that conformed to selected Panel recom-
454
mendations for estimating cost-effectiveness ratios.
This table is designed to address criticisms that
cost-effectiveness ratios from different studies are
not comparable because methods may differ widely.
SELECTION CRITERIA FOR STANDARDIZED
LEAGUE TABLE
We used the following Reference Case recommen-
dations to identify the subset of data points to in-
clude in the standardized league table: adoption of
a societal perspective, community or patient pref-
erence weights, use of net costs, appropriate incre-
mental comparisons, and discounting of costs and
QALYs at the same rate. These recommendations
are summarized below.
Societal perspective. Reference Case analyses are
intended to aid societal resource allocation deci-
sions. The Panel noted that to allocate societal re-
sources efficiently, all relevant costs and benefits
should be included, and therefore Reference Case
analyses should adopt a societal perspective. Be-
cause only about half of the studies in the database
explicitly stated the adopted perspective, we used
our own judgment of each study’s perspective. Also,
because relatively few studies (53, or 23%) used a
true societal perspective (e.g., including non-health
costs such as time or travel costs), we relaxed this
criterion to include data points from any study that
we judged took a societal or broad health-care sec-
tor perspective (i.e., inclusion of all health-care costs
regardless of who incurred them).
Preference weights from community or patients.
The Panel argued that community preferences (that
is, those of the general population) are best for Ref-
erence Cases, because they are more likely to rep-
resent societal preferences for resource allocation.
However, the Panel also noted that patient prefer-
ences for health states would be acceptable in a Ref-
erence Case analysis, if community preferences are
not available and are prohibitively difficult to mea-
sure. We therefore include studies that used either
the general population or patients as the source of
health-state preferences (thus excluding studies that
relied on clinicians’ or authors’ judgments of pref-
erence weights).
Use of net costs. Health
care interventions not only
incur short-term costs or benefits, but also may off-
set downstream costs by preventing long-term mor-
bidity. Reference Case analyses should therefore cal-
culate costs net of any such downstream savings.
The Panel also recommended the inclusion of direct
health care costs as well as direct non-health care
and time costs. While almost all of the studies in this
database (99%) included some direct health care
costs, fewer (17%) included any non-health care or
time costs.6 We included only analyses that calcu-
lated costs net of any downstream savings, as rec-
ommended by the Panel, but did not screen studies
for the types of costs included.
Appropriate incremental comparisons. Some stud-
ies reported an average cost-effectiveness ratio for
a program, rather than incremental ratios between
programs. An average cost-effectiveness ratio is one
calculated in comparison with a hypothetical no-
cost, no-life-expectancy baseline rather than in com-
285)
parison with the next-most-effective program.16(P
For studies that reported sufficient data, we con-
verted average CU ratios to incremental ratios
FIGURE 1. Distribution of estimated cost-utility
ratios
 455

Table 2 * Median Cost-Utility Ratios by Type of Intervention

by identifying the appropriate comparison program

and recalculating the cost-per-QALY ratio. The stan-
dardized league table includes only analyses with
appropriate incremental CU ratios.
Discounting of costs and Q~ILYs. The Panel rec-
ommends discounting of both costs and health con-
sequences at the same rate (3%). They also recom-
mend sensitivity analyses with a discount rate of 5%,
to allow comparison with previous studies. For the
standardized table, we included data points from
any article that discounted costs and health effects
at the same rate, either 3% or 5%, or for which the
time horizon was one year or less, so that discount-
ing was not necessary.

Results
The 228 CUAs included data for 647 intervention-
comparator pairs, which are collected in a compre-
hensive league table, along with associated cost-
effectiveness ratios in 1998 dollars per QALY. The
comprehensive league table is not shown here, but
is available on our Web site, (www.hsph.harvard.
edu/organizations/hcra/hcra.html). The interven-
tions are grouped by disease category and by type
of intervention within disease categories. Sixty-nine
(10.6%) of the interventions were reported to be cost-
saving and 64 (9.9%), dominated. The distribution of
estimated CU ratios ranged from cost-saving to
$52,000,000/QALY, with an overall median (excluding
dominated interventions) of $12,000/QALY (figure 1).
The distribution is positively skewed, with 69% of the
647 interventions estimated to have CU ratios of
$50,000 or less, and 78%, $100,000 or less.
When categorized into different types of interven-
tions, the median CU ratios varied considerably (ta-
ble 2), ranging from a median of $2,000/QALY for
immunizations to $140,000/QALY for &dquo;other medical
Prevention level
FIGURE 2 Cost-utility ratios by intervention’s level of prevention
(outliers excluded) Thick lines indicate medians, and boxes the
interquartile ranges.
tions). However, the median CU ratios were under
$70,000/QALY for all intervention types except those
classifiedas other medical procedures. The other-
medical-procedures category includes some inter-
ventions that have the highest estimated CU ratios
in our database, such as preoperative autologous
blood donations. The numbers of ratios recorded in
the database also varied greatly by intervention type
(table 2), with the largest categories being pharma-
ceutical and surgical interventions (with 233 and 119
ratios, respectively).
The interventions were also classified according
to level of prevention: primary, secondary, or terti-
ary (that is, treatment). Primary prevention included
measures intended to prevent the onset of targeted
conditions; secondary prevention was defined as
measures aimed at identifying and treating asymp-

procedures&dquo; (again excluding dominated interven- tomatic persons who have already developed risk
456
Table 3 * Median Cost-Utility Ratios by ICD-9 Disease
*Includes intenrentions thatwere not aimed at specific diseases, or included more than one disease category.
fThe congenital anomalies category included one non-dominated intervention, estimated to be cost-saving; the pregnancy, childbirth, and puerpenum
category included one intervention, with an estimated ratio of $1,500/QALY.
factors or pre-clinical disease.24 Tertiary prevention
refers to treatment for clinical diseases or condi-
tions. As shown in figure 2, the median CU ratios
are comparable for health-care interventions aimed
at primary secondary, and tertiary prevention (at
$14,000, $14,000, and $11,000 per QALY, respec-
tively). However, the ratios for primary prevention
interventions were much more varied than those for
secondary or tertiary prevention (with an interquar-
tile range of $407,000 for primary vs $34,000 for sec-
ondary and $39,000 for tertiary prevention).
The numbers of analyzed interventions varied
considerably by disease category (table 3), with some
relativelywell studied, such as circulatory system,
infectious and parasitic, and neoplasms. Other dis-
ease categories, such as congenital anomalies, injury
and poisoning, and pregnancy, childbirth and pu-
Table 4 * Numbers of interventions and Articles Meeting
Selected Reference Case Criteria
Category
erperium, hadten or fewer interventions for which
CUAs had been conducted. The median CU ratios
ranged from cost-saving for interventions targeted
at diseases of the blood and blood-forming organs
to $40,500/QALY for interventions in respiratory sys-
tem diseases (table 3).
Applying our selected Reference Case criteria, we
found that CUAs for 95% of the interventions were
judged to take a societal or broad health-care sector
perspective (table 4). Analysts used the general com-
munity or patients as the source of preference
weights for 39% of the intervention-comparator
pairs. Net costs (defined as costs net of any down-
stream savings) were calculated for 83% of the ratios.
Appropriate incremental comparisons had been
performed for 49% of the ratios. Analysts appropri-
ately discounted both costs and QALYs for 80% of
the CU ratios. Overall, 112 of the 647 interventions
(or 37 of the 228 articles) used all of these recom-
mended basic analytic methods, representing 17% of
the ratios in the database (table 4; appendix). The
number of interventions meeting the selected Ref-
erence Case criteria over time is shown in figure 3.
A higher proportion of the interventions published
in recent years than those published before 1991
were in the &dquo;Panel-worthy&dquo; subset (figure 3). These
&dquo;Panel-worthy&dquo; interventions and their associated
ratios are listed in the appendix to this article.
Discussion
The comprehensive league table includes 647
cost-per-QALY ratios that vary across a range from
 457

cost-saving to $52,000,000/QALY to dominated. This

variation is related not only
to the intervention being
studied, but also to the type of intervention, disease
category, and prevention level. While we found that
only 17% of the ratios in our database adhered to
the selected USPHS Panel guidelines, figure 3 pro-
vides some evidence that, over time, analysts may be
converging toward a consensus on methodologic
practices, a trend that should only be accelerated by
the publication of the Panel’s guidelines in 1996.
This study adds to previous work in the field by
concentrating on studies that report costs per QALY,
and by incorporating the Panel’s recommendations
for the conduct of cost-effectiveness analyses. While
there have been comprehensive bibliographies of
economic evaluations in genera 121,11 (and extensive
league tables of cost-effectiveness analyses using
costs per life year as their metric27)} this article fo- Year of publication (grouped)
cuses only on analyses that report costs per QALY,
FIGURE 3. Numbers of interventions, grouped by year of publi-
as the metric recommended by the USPHS Panel on cation, and numbers meeting selected Reference Case criteria
Cost-Effectiveness in Health and Medicine. The (Pearson chi-square = 40.2 with 4 degrees of freedom, p <
0.001).
comprehensive, Web-based CUA database can help
decision makers to make more meaningful compar-
isons of diverse medical interventions. By consulting
the original published analyses, users can assess the per QALY but were not indexed under these headings.
Even within the standardized, &dquo;Panel-worthy&dquo; ta-
comparability, relevance, and reliability of the re-
ble, some limitations apply. Studies may not be com-
ported CU ratios. But while analyses of the compre-
hensive CU ratio list provide a useful reference of parable because of differences in the underlying
data and assumptions, not just from whether or not
the field up until 1998, they also illustrate the chal-
lenge of comparing ratios given wide methodologic they meet Reference Case criteria. For example,
Brown and Fintor, in a comparison of published
variations. Mason3has classified critiques of cost-
cost-effectiveness analyses of breast cancer screen-
per-QALY league tables into two main types: one fo-
cused on the appropriate way to present league- ing} 28 found that costs per life-year for comparable
table information, and the other on theoretical screening programs varied widely because of un-
derlying differences in modeling assumptions. We
problems with using league tables to improve allo- have not attempted to judge the quality of the clin-
cative efficiency. This article addresses the former
ical assumptions or data inputs used in an analysis.
criticism by highlighting ratios from those analyses
A study may meet all of the Panel’s methodologic
that used uniform, recommended methods for con-
criteria, but still lead to misleading results because
ducting CUAs. The &dquo;Panel-worthy&dquo; subset of CU ra- of questionable clinical assumptions or poor-quality
tios may serve as a better benchmark for compari- data on effectiveness, quality of life, or costs. Be-
sons with new analyses, especially those intended
cause of this, our classification of CUAs as &dquo;Panel-
for use as reference cases.
worthy&dquo; should not necessarily be seen as a judg-
There are several limitations to the analyses and ment of the overall quality of an analysis. Also, we
league table presented here. While our literature selected only studies that met key recommenda-
search included several computerized databases, we
tions, and not necessarily all of the Panel’s Refer-
did not identify CUAs that were either available in ence Case standards. Finally, there are changes
non-listed publications or not published at all. Be- across time and geography in health care tech-
cause we are limited to published studies, any pub-
niques, and in resource use and valuation. There-
lication bias in CUAs would be reflected in the da- fore, ratios within the Panel-worthy standardized
tabase, as well as what might be called study bias, league table should not be considered completely
in that certain diseases and intervention types are comparable without examination of the assump-
relatively well studied (for example, pharmaceuti- tions and data shaping the original analyses, with
cals) compared with others. In addition, because we attention to changes that may have occurred since
narrowed our search to certain key words (&dquo;quality- publication. We recommend that readers consult
adjusted,&dquo; &dquo;QALY,&dquo; or &dquo;cost-utility&dquo;), we may have the original articles to form their own judgments of
missed some published studies that estimated costs the overall quality of each analysis.
458

Even with these limitations, listing the results of Economic analysis in randomized control trials Med Care.
1992;30:231-43.
analyses together in a league-table format can reveal 9. Udvarhelyi IS, Colditz GA, Rai A, Epstein AM. Cost-effective-
useful information. The analyses presented here, ness and cost-benefit analyses in the medical literature. are

along with publication of the comprehensive league the methods being used correctly? Ann Intern Med. 1992;
table on the Web, provide a snapshot of the state of 116:238-44.
the field through 1997, and reveal which diseases or 10 Nord E. Toward quality assurance in QALY calculations. Int
J Technol Assess Health Care. 1993;9:37-45.
intervention types have been relatively well studied
and which neglected. By standardizing on basic
11. Briggs A, Sculpher M. Sensitivity analysis in economic eval-
uation: a review of published studies. Health Econ. 1995;4:
methodologic criteria, the &dquo;Panel-worthy&dquo; league ta- 335-71.
ble in the appendix allows some assessment of CU 12. Blackmore CC, Magid DJ. Methodologic evaluation of the ra-
ratios across diverse health care interventions. It diology cost-effectiveness literature. Radiology. 1997;203:87-
91.
also provides a benchmark with which to compare
13. Graham JD, Corso PS, Morris JM, Segui-Gomez M, Weinstein
future reference case analyses. MC. Evaluating the cost-effectiveness of clinical and public
We believe that posting these league tables on the health measures Annu Rev Public Health. 1998;19:125-52.
Web will increase their usefulness to policymakers 14. Jefferson T, Smith R, Yee Y, Drummond M, Pratt M, Gale R.
and health-care decision makers. We plan to update Evaluating the BMJ guidelines for economic submissions:
these tables and make them increasingly interactive prospective audit of economic submissions to BMJ and The
Lancet. JAMA. 1998;280:275-7.
in future versions, allowing users to examine the 15. Gerard K, Smoker I, Seymour J. Raising the quality of cost-
cost-effectiveness of interventions in various ways. utility analyses: lessons learnt and still to learn. Health Policy.
For example, a user could prepare disease-specific 1999;46:217-38.
16. Gold MR, Siegel JE, Russell LB, Weinstein MC (eds.). Cost-
league tables to address the question of what is the Effectiveness in Health and Medicine. Oxford, U.K.: Oxford
most efficient way to reduce mortality and morbidity
University Press, 1996.
from cancer, heart disease, and other conditions, or 17. Weinstein MC, Gold MR, Kamlet MS, Russell LB,
Siegel JE,
search for interventions targeting the same popula- for the Panel on Cost-Effectiveness in Health and Medicine
tion to compare the cost-effectiveness of pharma- Recommendations of the Panel on Cost-Effectiveness in
Health and Medicine. JAMA. 1996;276:1253-8.
ceutical and surgical interventions for a specific
18. Laupacis A, Feeny D, Detsky AS, Tugwell PX. How attractive
condition. Finally, we believe that one of the most does a new technology have to be to warrant adoption and
valuable aspects of this review is to examine the ev- utilization? Tentative guidelines for using clinical and eco-
olution of the field over time. nomic evaluations. Can Med Assoc J 1992;146:473-81.
19. Graham JD, Vaupel JW. Value of a life: what difference does
it make? Risk Analysis. 1981;1:89-95.
The authors are grateful to John D. Graham and two anonymous 20. Federal Reserve Bank of St. Louis. Monthly exchange rates
reviewers for helpful comments on drafts of the manuscript. series; extracted March 17, 1999. Available from: &pr;http://
www.stls.frb.org/fred/data/exchange.html&rang;.
21. Bureau of Labor Statistics. Consumer Price Index&mdash;All Ur-
ban Consumers. Series ID: CUUROOOOSAO; extracted March
References 17, 1999. Available from: &pr;http://146.142.4.24/cgi-bin/survey
most?bls).
1. Gerard K. Cost-utility practice: a policy maker’s guide
in to 22. Aaron HJ. Health care spending: an analytical forum: I.
the state of the art. Health Policy. 1992;21:249-79. medical costs. Health Affairs. Winter
Thinking straight about
2. Drummond M, Torrance G, Mason J. Cost-effectiveness 1994:8-13.
league tables: more harm than good? Soc Sci Med. 1993;37: 23. Huskamp HA, Newhouse JP. Health care spending: an ana-
33-40.
lytical forum: III. Is health spending slowing down?. Health
3 Mason JM. Cost-per-QALY league tables: their role in phar- Affairs. Winter 1994:8-13.
macoeconomic analysis. PharmacoEconomics. 1994;5:472- 24. United States Preventive Services Task Force. Guide to Clin-
81. ical Preventive Services. 2nd ed. Baltimore, MD: Williams and
4. De Graeve D, Nonneman W. Pharmacoeconomic studies: pit- Wilkins; 1996.
falls and problems. Int J Technol Assess Health Care. 1996; 25. Elixhauser A, Halpern M, Schmier J, Luce BR. Health care
12:22-30. CBA and CEA from 1991 to 1996: an updated bibliography.
5. Neumann PJ, Stone P, Chapman RH, Sandberg E, Bell C. The Med Care. 1998;36:MS1-MS9, MS18-MS147.
quality of reporting in published cost-utility analyses, 1976- 26. Elixhauser A, Luce BR, WR, Reblando J. Health care
Taylor
1997. Ann Intern Med.
2000;132:964-72. CBA/CEA: an update on the and composition of the
growth
6. Stone PW, Chapman RH, Sandberg EA, Liljas B, Neumann literature. Med Care. 1993;31:JS1-JS138.
PJ. Measuring costs in cost-utility analyses: variations in the 27. Tengs TO, Adams ME, Pliskin JS, et al. Five-hundred life-
literature. Int J Technol Assess Health Care. 2000;16:111-24. saving interventions and their cost-effectiveness. Risk Anal-
7. Neumann PJ, Zinner DE, Wright JC. Are methods for esti- ysis. 1995;15:369-90.
mating QALYs in cost-effectiveness analyses improving? Med 28 Brown ML, Fintor L. Cost-effectiveness of breast cancer
Decis Making. 1997;17:402-8. results of a systematic review of the
screening: preliminary
8. Adams ME, McCall NT, Gray DT, Orza MJ, Chalmers TC. literature. Breast Cancer Res Treat. 1993;25:113-8.