When is cancer care cost-effective? A systematic overview of cost-utility analyses in oncology

Abstract

New cancer treatments pose a substantial financial burden on health-care systems, insurers, patients, and society. Cost-utility analyses (CUAs) of cancer-related interventions have received increased attention in the medical literature and are being used to inform reimbursement decisions in many health-care systems. We identified and reviewed 242 cancer-related CUAs published through 2007 and included in the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org). Leading cancer types studied were breast (36% of studies), colorectal (12%), and hematologic cancers (10%). Studies have examined interventions for tertiary prevention (73% of studies), secondary prevention (19%), and primary prevention (8%). We present league tables by disease categories that consist of a description of the intervention, its comparator, the target population, and the incremental cost-effectiveness ratio. The median reported incremental cost-effectiveness ratios (in 2008 US $) were $27,000 for breast cancer, $22,000 for colorectal cancer, $34,500 for prostate cancer, $32,000 for lung cancer, and $48,000 for hematologic cancers. The results highlight the many opportunities for efficient investment in cancer care across different cancer types and interventions and the many investments that are inefficient. Because we found only modest improvement in the quality of studies, we suggest that journals provide specific guidance for reporting CUA and assure that authors adhere to guidelines for conducting and reporting economic evaluations.

Figure 1

Growth of the cost–utility literature over time. The rate at which cost–utility analyses (CUAs) are published in the medical and health economic literature has risen markedly over time. Overall, 14% of the studies in the Tufts Medical Center Cost-Effectiveness Analysis Registry pertained to cancer, and this proportion did not change substantially over time.

Figure 2

Distribution of published incremental cost-effectiveness ratios (ICERs) in cancer studies. 8.2% of the cancer-related interventions were reported to be both cost-saving and more effective (dominant), and 52.2% were reported to have an ICER of less than $50 000 per quality-adjusted life-year (QALY) gained. The ICER was greater than $100 000 per QALY gained in 14.0% of interventions examined, and interventions were cost-increasing and less effective (dominated) in 10.8% of analyses.