A. Benedict1, M. Chenoweth1, H. Jen1 1Tufts Medical Center,Boston, MA, USA
Introduction: Cost-utility analysis (CUA) assesses healthcare interventions by measuring value in terms of incremental cost per quality-adjusted-life-year (QALY) gained. CUA can comprehensively assess a wide range issues in the care of surgical patients. To date, comprehensive assessment of the CUA literature in surgery has not been conducted. The purpose of our study was to investigate the use and quality of CUA in surgical research.
Methods: A comprehensive Cost-Effectiveness Analysis (CEA) Registry, which catalogs more than 4297 peer-reviewed English-language CUAs through 2013, was used. This registry performs yearly systematic review of the CUA literature since 1976 and collects publication information, methodological characteristics, cost effectiveness ratios as well as utility weights from each article. Study characteristics were analyzed over three time periods: 1990-1999, 2000-2009, and 2010-2013. The quality of CUAs in the registry was rated on a 7-point scale. General surgery disciplines (GS) include general, bariatric, cardiothoracic, colorectal, oncologic, pediatric, transplant, trauma, and vascular surgeries. Trends were compared using the Cochran-Armitage trend test and designated significant if p<0.05.
Results: Out of the 4297 CUA articles in the CEA Registry, 647 (15.06%) focused on surgical interventions. The number of surgical CUA publications per year increased from 7.6 articles per year in 1990-1999 to 62.3 articles per year in 2010-2013 (p<0.03 for trend; see figure). This rate of increase was dwarfed by the increase in non-surgical CUA publications (26.3 articles per year in 1990-1999 to 395.8 articles per year in 2010-2013; p<0.005). The proportion of CUAs evaluating GS disciplines compared to other surgical subspecialties decreased significantly over time (from 55.2% in 1990-1999 to 41.6% in 2010-2013; p<0.001). The quality of CUAs was similar when comparing GS discipline to non-surgical CUAs (4.47 vs. 4.54, p=0.18). However the quality of GS discipline CUAs was superior compared other surgical subspecialties (4.47 vs. 4.19, p<0.005). There was also a significant increase in the proportion of surgical CUA publications from low- and middle-income countries (0% in 1990-1999 to 5.2% in 2010-2013; p<0.01).
Conclusion: There has been a significant growth in use of cost-utility analysis in surgical research, but the rate of increase still lags behind non-surgical subspecialties. Although the proportion of general surgery CUAs compared to other surgical subspecialties have decreased overtime, the quality of general surgical CUAs was superior. Furthermore, our data also suggest a growing interest in surgical CUAs by low- and middle-income countries.
