Cost-Effectiveness Analysis in Radiology: A Systematic Review

Purpose: Cost-effectiveness analyses (CEAs) have become more prevalent in radiology. However, the lack of standard methodology may lead to conflicting conclusions on the cost-effectiveness of an imaging modality and hinder CEA-based policy recommendations. This study reviews recent CEAs to identify areas of methodological variation, explore their impact on interpretation, and discuss optimal strategies for performing CEAs in radiology. Methods: We performed a systematic review for cost-utility analyses in radiology from 2013 to 2017. Cost and quality-of-life methods were analyzed and compared using the Consolidated Health Economic Evaluation Reporting Standards checklist. Results: Eighty cost-utility studies met our inclusion criteria. A payer perspective was the most common (70%) and hospital perspective the least common (5%). Fourteen studies (17.5%) did not report perspective, and 12 (15%) reported a perspective inconsistent with their performed analysis. Cost inclusion varied greatly between studies; adverse effects of imaging (20.5%) and hospitalization (34.6%) were the least frequently included direct costs. Studies that measured their own utilities most commonly used the EuroQol-5D and Short Form-6D questionnaires; however, most studies (80%) cited utilities from previous literature. Seventy-two studies (90%) used willingness-to-pay thresholds, and 30 used cost-effectiveness acceptability curves (41.7%). Conclusion: We observed statistically significant methodological variation indicating the need for a standardized, accurate means of performing and presenting CEAs within radiology. We make several recommendations to address key problems regarding study perspective, cost inclusion, and use of willingness-to-pay thresholds. Further work is required to ensure comparability and transparency between studies such that policymakers are properly informed when utilizing CEA results.