Departments of Medicine and Surgery, Geffen School of Medicine, University of California, Los Angeles, 200 Medical Plaza, Ste 214, Los Angeles, CA 90095-7302. E-mail: ssaab@ mednet.ucla.edu.
Background: Cost-effectiveness analyses compare the value of different treatment strategies, given that one strategy is more effective but also more costly than the other. The results are often used as a pharmacoeconomic basis to support a particular treatment strategy. Objectives: To determine whether studies that reported favorable cost-effectiveness results in the antiviral treatment of hepatitis B and hepatitis C were more likely to be published. Methods: A systematic literature search was performed to identify all original cost-effectiveness studies published from 1987 through 2011 regarding antiviral treatment of hepatitis B or hepatitis C. Data were abstracted independently by 2 reviewers. Corresponding authors were also contacted. Results: Of the 77 original cost-effectiveness analyses, 55 (71.4%) utilized a cost-effectiveness ratio below $50,000 per quality-adjusted life-year (QALY) in reaching a main conclusion for the study. A total of 46 analyses (59.74%) utilized ratios below $20,000/QALY. Most analyses (71 [92.2%]) reported favorable cost-effectiveness results. Countries outside of the United States and Europe tended to report lower cost-effectiveness ratios. Academic-funded studies were less likely to report cost-effectiveness ratios below $20,000/QALY. Most of the corresponding authors stated that their cost-effectiveness studies were published. Conclusions: Most published cost-effectiveness analyses regarding antiviral treatment of hepatitis B or hepatitis C reported favorable results. These results may suggest that researchers only attempt cost-effectiveness studies when there is a high likelihood of positive results. Regardless of the explicit cause of the bias, more awareness and scrutiny are needed when utilizing cost-effectiveness studies in decision making.