Impact of the U.S. panel on cost-effectiveness in health and medicine

Objective: To examine whether recommendations made by the U.S. Panel on Cost-Effectiveness in Health and Medicine (Panel Report) have been associated with changes in how cost-effectiveness analyses are conducted. Methods: We examined whether studies published after the Panel Report was issued and which cited the Panel Report were more likely to follow its recommendations on discounting, quality-adjusted life years (QALYs), and incremental ratios than (1) studies published before the Panel Report, and (2) studies published after the Panel Report but that did not cite the Panel Report. We used the Science Citation Index to identify all studies citing the Panel Report that were also empirical, cost-effectiveness analyses (n=18). We randomly selected two groups for comparison (N=54). Studies were compared using contingency tables. Results: Significantly more studies that cited the Panel Report used a 3% discount rate than did post-report comparison studies (p=0.03) and pre-report comparison studies (p=0.03). There was a nonsignificant trend for studies citing the Panel Report to be more likely to use QALYs and incremental ratios (range of p=0.11 to p=0.20). Conclusions: We found evidence that the Panel Report had an impact on practice. However, 31% of the studies citing the Panel Report did not follow the recommendation to use a 3% discount rate, and only 28% followed all three recommendations.