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The goal of the reporting chapter is to provide guidance on reporting cost-effectiveness analyses (CEAs) with an emphasis on clarity and transparency. The chapter provides recommendations for each area of a CEA: design, methods and analysis, results, and discussion. It also presents several new areas, such as the need for more clarity in identifying the perspective of the analysis; a structured abstract format; and updated guidance on disclosure of conflicts of interest. Finally, we highlight the importance of reporting intermediate endpoints and disaggregated results, and of providing a detailed presentation of the Impact Inventory to best support the use of CEA in decision making.

The original Panel recommended a societal Reference Case as a point of comparison across studies. The Second Panel reconsidered at length the perspectives that Reference Case analyses should use. Many, if not most published cost-effectiveness analyses (CEAs) have not used a true societal perspective. Further, decision-making bodies that have incorporated CEA into health technology assessment to inform coverage and reimbursement decisions have not adopted a societal perspective. Given this backdrop and various options, the Second Panel recommends that all studies report two Reference Case analyses: one based on a healthcare sector perspective and one based on a societal perspective. We recommend that analysts present all items in an analysis as disaggregated consequences in an Impact Inventory to ensure that all consequences, including those outside the formal healthcare sector, are considered regularly and comprehensively, as they have generally not been to date.

This chapter provides an overview of how to design a cost-effectiveness analysis (CEA). The chapter highlights the importance of early conceptualization and planning steps to define the objectives, the research question, the perspective(s), the intervention(s), the target population, the comparators, the scope, the time horizon, and the analysis plan for a cost-effectiveness study. The chapter recommends that analysts conduct Reference Case analyses from both the healthcare sector perspective and the societal perspective. We also recommend that analysts use an Impact Inventory, which lists the consequences across sectors (e.g., healthcare, education, criminal justice system) affected by an intervention, and that they develop a written protocol that details key aspects of the CEA’s design and conduct.

This chapter examines the process of identifying, quantifying, and valuing the resource costs and non-pecuniary benefits associated with the use and consequences of healthcare interventions. The Second Panel categorizes the types of resources that most interventions require and describes how they are included in a cost-effectiveness analysis. A key departure from the work of the original Panel is the consideration of cost categories from two Reference Case perspectives, the healthcare sector perspective and the larger societal perspective. The Second Panel also recommends that some components (e.g., current and future medical costs and patients’ out-of-pocket costs) should pertain to both sectors, whereas others (e.g., time costs for patients and caregivers, transportation costs, productivity benefits, consumption costs, and other sector costs) should be counted only for the societal reference case perspective. Valuation of these resources follows the principle of opportunity costs.

This chapter discusses the potential of cost-effectiveness analysis (CEA) in health and medicine and the ways in which the technique has been applied. Since the original Panel’s work, CEA has become a more common feature on the healthcare landscape. Researchers have investigated the cost-effectiveness of a wide range of interventions in diverse applications. In the United States and abroad, public and private health organizations have funded, conducted, and used CEAs, though the technique has also encountered resistance. Decision makers involved in resource allocation decisions have given the greatest weight and deepest consideration to the clinical evidence underlying interventions. They have generally viewed CEA as one input, alongside other considerations, including ethical, legal, and political concerns.

This chapter, which covers the role of discounting, follows the recommendations of the original Panel, as well as other economic evaluation guidelines, in recommending that analysts discount future costs and health effects, presenting cost-effectiveness ratios in present value terms so that decision makers can compare each ratio from the same temporal baseline. The chapter updates the original Panel’s discussion of rationales for discounting and different approaches for selecting discount rates. The chapter follows the original Panel in recommending that in Reference Case analyses, costs and health effects should be discounted at the same rate and presents the Second Panel recommendation to continue to use 3% as the most appropriate real discount rate for CEAs, while acknowledging the continued importance of sensitivity analyses.