A synthesis of cost-utility analysis literature in infectious disease

The purpose of this review is to understand infectious disease-related cost-utility analyses by describing published analyses, examining growth and quality trends over time, examining factors related to quality, and summarising standardised results. 122 cost-utility analyses and 352 cost-utility ratios were identified. Pharmaceutical interventions were most common (47·5%); three author groups accounted for 42·8% of pharmaceutical ratios. High-volume journals (three or more published cost-utility analyses) published higher quality analyses than low-volume journals (p<0·001). Use of probabilistic sensitivity analysis and discounting at 3% were more frequently found in the years after the US Public Health Service Panel on Cost-Effectiveness in Health and Medicine recommendations (p<0·01). Median ratios varied from US$13 500/quality-adjusted life year (QALY) for immunisations to US$810 000/QALY for blood safety. Publication of infectious disease cost-utility analyses is increasing. The results of cost-utility analyses have important implications for the development of clinical guidelines and resource allocation decisions. More trained investigators and better peer-review processes are needed.