Australian health economic evaluation – 245 interventions : what can we say about cost effectiveness ?

Background: There is an increasing body of published cost-utility analyses of health interventions which we sought to draw together to inform research and policy. Methods: To achieve consistency in costing base and policy context, study scope was limited to Australian-based cost-effectiveness analyses. Through a comprehensive literature review we identified 245 health care interventions that met our study criteria. Results: The median cost-effectiveness ratio was A$18,100 (~US$13,000) per QALY/DALY/LY (quality adjusted life year gained or, disability adjusted life year averted or life year gained). Some modalities tended to perform worse, such as vaccinations and diagnostics (median cost/QALY $58,000 and $68,000 respectively), than others such as allied health, lifestyle, in-patient interventions (median cost/QALY/DALY/LY all at ~A$9,000~US$6,500). Interventions addressing some diseases such as diabetes and impaired glucose tolerance or alcohol and drug dependence tended to perform well (median cost/QALY/DALY/LY < A$3,700, < US$5,000). Interventions targeting younger persons < 25 years (median cost/QALY/DALY/LY < A$41,200) tended to perform less well than those targeting adults > 25 years (median cost/QALY/DALY/LY < A$16,000). However, there was also substantial variation in the cost effectiveness of individual interventions within and across all categories. Conclusion: For any given condition, modality or setting there are likely to be examples of interventions that are cost effective and cost ineffective. It will be important for decision makers to make decisions based on the individual merits of an intervention rather than rely on broad generalisations. Further evaluation is warranted to address gaps in the literature and to ensure that evaluations are performed in areas with greatest potential benefit. Background Because resources are limited not all potentially beneficial services can be funded. Choices must be made in allocating scarce resources. Economic evaluation can help inform resource allocation choices by comparing costs and consequences of two or more alternatives. Comparisons between interventions will be more robust where they are country specific, at least in terms of input costs, which differ considerably between countries. To date Australian economic evaluations have not been systematiPublished: 20 May 2008 Cost Effectiveness and Resource Allocation 2008, 6:9 doi:10.1186/1478-7547-6-9 Received: 1 November 2007 Accepted: 20 May 2008 This article is available from: http://www.resource-allocation.com/content/6/1/9 © 2008 Dalziel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Page 1 of 12 (page number not for citation purposes) Cost Effectiveness and Resource Allocation 2008, 6:9 http://www.resource-allocation.com/content/6/1/9 cally described, appraised or explored, except for decisions of the PBAC (Pharmaceutical Benefits Advisory Council) between 1991 to 1996[1]. However, given confidentiality of data, the performance of specific interventions was not reported. There is now a substantial body of published health economic evaluations in Australia that have used 'final and global' measures of performance (life years, quality adjusted life years and disability adjusted life years) which allows comparison across health care interventions. The aim of the current paper is to describe and explore Australian published economic evaluations and to analyse the distribution of published cost-effectiveness ratios. This analysis will determine whether there is any identifiable pattern in published cost-effectiveness ratios. The results will potentially to assist policy makers with resource allocation decisions and will identify gaps in the types of interventions evaluated. Methods Searching for cost-effectiveness studies The Medline OVID database from 1966 to present was searched in April 2005 for relevant studies using key words for "cost effectiveness" and "economic evaluation" combined with the key word "Australia". In addition websites of Australian health economics centres and government health departments were searched [See Additional file 1].