The pursuit of transparency and quality improvement in cost-effectiveness analysis - a case study in disease-modifying drugs for the treatment of multiple sclerosis.

Cost-effectiveness analysis (CEA) can be a powerful analytic tool for assessing the value of health care interventions when used in conjunction with efficacy, safety, and other supporting data in an evidence-based decision making environment. CEA is commonly defined in terms of the comparison of costs, expressed in monetary units, with outcomes that may be expressed in a variety of ways. One of the most common forms of CEA compares costs in monetary units with outcomes quantified in nonmonetary units (e.g., cancer avoided, death avoided, or successfully treated patient). Cost-utility analysis (CUA) is a form of CEA that compares costs in monetary units with outcomes quantified as a multidimensional measure of effectiveness (e.g., utilities that are used to estimate quality-adjusted life-years [QALYs]). Cost benefit analysis (CBA), another form of CEA that is used less frequently, compares costs and benefits (i.e., outcomes) both of which are quantified in monetary units. Overall, there has been an increasing trend in the use of CEA (CEA, CUA, and CBA) to inform decision making. This trend can be implicitly measured by the frequency of published CEAs over time.