A Bibliometric Review of Cost-Effectiveness Analyses in the Economic and Medical Literature: 1976-2006

Background. Cost-effectiveness analysis (CEA) presenting a cost per quality-adjusted life year (QALY) ratio is frequently used to determine value for money in health care. Despite the proliferation of CEA research, there has been no detailed study focusing on the bibliometric properties of this literature. Objectives. To describe and analyze trends in publications and coauthorship in the CEA literature from 1976 to 2006 and to identify the most prolific authors and research groups conducting CEAs. Methods. The authors used the Tufts Medical Center Registry of original CEAs published through 2006 (www.cearegistry.org). For each article, they recorded the year of publication, the journal title, and the number of contributing authors and their names. Authors were assigned credit based on their weighted contribution to the study (1 credit point for the first and last authors, point for the second author, and 1/n credit points for all other authors, where n reflects the number of coauthors). Results. Approximately 1400 CEAs presenting a cost/QALY ratio were published in 420 journals through 2006. The mean number of contributing authors was 4.7 +/- 2.4. Medical journals were characterized by a higher number of coauthors, as compared with the economic and health policy journals: 4.8 +/- 2.4 v. 4.2 +/- 2.0, P < 0.001. The lowest average number of coauthors was in Medical Decision Making (3.6) and the highest in the Journal of the American College of Cardiology (8.2). The most prolific authors were affiliated with Harvard and Tufts Universities and their affiliated hospitals. The authors identified 4 major research groups that contributed substantially to the field of cost-effectiveness analysis but did not find any substantial academic relationships across these groups. Conclusions. The CEA literature continues to proliferate. Coauthorship trends appear to follow the rapid increase in the mean number of authors found in other publication types.