Growth and Changing Landscape of the Cost-Utility Literature: An Australian Perspective, 1992-2022

Objectives: To provide a comprehensive overview of the volume, trends, and characteristics of the use of cost utility analysis (CUA) in healthcare decision making in Australia.Design and setting: Bibliometric analysis of published studies on CUA identified from the Cost-Effectiveness Analysis Registry, a comprehensive source of CUA data, between 1992-2022. Main outcome measures: Australian-based CUAs using cost-per-quality adjusted life years (QALYs) or cost-per-disability adjusted life years (DALYs) as the outcome, as well as the trends and relevant characteristics of the CUAs.Data synthesis: A total of 488 unique Australian-based CUAs were analysed (cost-per-QALY: n=398; cost-per-DALY: n=90). Over the last three decades, the volume and quality of CUAs in Australia have steadily increased. Interventions that were frequently evaluated were on pharmaceuticals (21.7%), health education/behaviour (18.0%), and models of care (16.7%), while diseases of the circulatory system, cancers, and metabolic diseases were the most studies health conditions. Most CUAs (72.7%) were conducted from a healthcare payer perspective, with only 19.0% adopting a broader societal perspective. A 5% discount rate applied in about half of studies. Half (50.6%) of the studies used a $50,000 WTP threshold, followed distantly by thresholds between $28,001-$49,999 (5.3%) or $28,000 (3.9%). Most studies were funded by academic/government sources (61.7%), while 14.5% were supported by the pharmaceutical or medical device industry. Overall, 60.2% of QALY studies reported an ICER less than $28,000, and 71.5% less than $50,000, resulting in a 11.3% gap. For DALY studies, there was a 12.3% gap (74.1% - 61.8%) in the proportions reporting ICERS between threshold of $28,000 and $50,000. Conclusions: The increasing volume of CUAs underscores the importance of efficient allocation of scare resources in the Australian health system. However, gaps remain in standardised reporting and reevaluating the alignment of discount rates and WTP thresholds with international standards, which require further research for more equitable healthcare resource allocation.