Cost-benefit and cost-effectiveness analysis in health care. Growth and composition of the literature.

Concern about the escalating costs of health services is reflected in the rapid growth of the literature on cost-benefit and cost-effectiveness analysis (CBA and CEA, respectively) in health care. A search of that literature for 1966--78 produced a bibliography of more than 500 relevant references, growing from half a dozen per year at the beginning of the period to close to 100 each of the most recent 2 years. The literature growth has been more rapid in medical than nonmedical journals and a preference for CEA over CBA appears to be emerging. Studies related to diagnosis and treatment have gained in popularity, while the early prominence of studies with a substantive prevention theme has diminished. Consistent with the increasing medical focus of the literature, numbers of articles oriented toward individual practitioner decision making have grown more rapidly than those oriented toward organizational or societal decision making. In addition to documenting these trends, this article identifies published reviews of health care CBA/CEA and books and articles attempting to convey the principles of CBA/CEA to the health care community. The article concludes with speculation on likely near-future trends in the literature and consideration of the quality implications of the rapid growth.