Intended for healthcare professionals


Promoting confidence in cost-effectiveness analyses

BMJ 2022; 377 doi: (Published 22 June 2022) Cite this as: BMJ 2022;377:o1452

Linked Research

Industry sponsorship bias in cost effectiveness analysis

  1. Adam J N Raymakers,, senior health economist1,
  2. Aaron S Kesselheim,, professor2
  1. 1Cancer Control Research, BC Cancer, Vancouver, BC, Canada
  2. 2Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
  1. Correspondence to: A S Kesselheim akesselheim{at}

Solutions to tackle bias are more important than ever

In a linked paper, Xie and colleagues (doi:10.1136/bmj-2021-069573)1 report a comprehensive investigation into the presence of bias in cost-effectiveness analyses conducted with sponsorship from the pharmaceutical or medical device industry. The authors used the Tufts Cost-Effectiveness Analysis Registry to analyse 8192 cost-effectiveness analyses, of which 29.7% were sponsored by industry. Industry-sponsored studies were twice as likely to report the intervention being studied as cost-effective at a willingness-to-pay threshold of $50 000 per quality adjusted life years (QALY) gained (odds ratio 2.06; 95% confidence interval 1.82-2.33). These findings are important because the studies listed in this comprehensive registry might directly influence organisations that use cost-effectiveness analysis in decision making.

Cost-effectiveness analysis can be a useful tool to aid system-level decision making about the adoption of new health technologies. However, this usefulness is directly related to the quality of the analysis and the confidence that decision-makers might have in its accuracy. Assumptions made during …

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