The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Cost-Effectiveness and Cost-Benefit Analyses in the Medical Literature: Are the Methods Being Used Correctly?

I. Steven Udvarhelyi, MD, MSC; Graham A. Colditz, MBBS, DrPH; Arti Rai, AB; and Arnold M. Epstein, MD, MA
[+] Article, Author, and Disclosure Information

Grant Support: Dr. Epstein was a Kaiser Foundation Faculty Scholar in General Internal Medicine when this work was initiated. Dr. Udvarhelyi was the recipient of a Medical Foundation Award.

Requests for Reprints: Arnold M. Epstein, MD, MA. Harvard Medical School, Department of Health Care Policy, 25 Shattuck Street, Parcel B, 1st floor, Boston, MA 02115.

Current Author Addresses: Dr. Udvarhelyi: Prudential Insurance Company, Group and Financial Services Office. 410-ROS2. 56 North Livingston Avenue, Roseland, NJ 07068.

Dr. Colditz: Channing Laboratories, Brigham and Women's Hospital. 180 Longwood Avenue, Boston, MA 02115.

Ms. Rai: c/o J. Bains, MD, 2307 South Park, Springfield, IL 62704.

Dr. Epstein: Harvard Medical School, Department of Health Care Policy, 25 Shattuck Street. Parcel B, 1st floor, Boston, MA 02115.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;116(3):238-244. doi:10.7326/0003-4819-116-3-238
Text Size: A A A
This excerpt has been provided in the absence of an abstract.

Objective: To determine whether published cost-effectiveness and cost-benefit analyses have adhered to basic analytic principles.

Design: Structured methodologie review of published articles.

Study Sample: Seventy-seven articles published either from 1978 to 1980 or from 1985 to 1987 in general medical, general surgical, and medical subspecialty journals.

Main Outcome Measurements: Articles were reviewed to assess the use and reporting of six fundamental principles of analysis. These principles were derived by reviewing widely cited textbooks and articles describing the methods for performing economic analyses and by selecting the methods universally recommended.

Main Results: Overall performance was only fair. Three articles adhered to all six principles, and the median number of principles to which articles adhered was three. Among the problems noted were failure to make underlying assumptions explicit and, therefore, verifiable, and failure to test assumptions with sensitivity analyses. No improvement in performance was observed between 1978 and 1987. Articles in general medical journals, however, were more likely to use analytic methods appropriately than articles in the general surgical or medical subspecialty literature.

Conclusions: Greater attention should be devoted to ensuring the appropriate use of analytic methods for economic analyses, and readers should make note of the methods used when interpreting the results of economic analyses.


First Page Preview

View Large
First page PDF preview





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.