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Purpose. We examined 512 published cost-utility analyses (CUAs) in the U.S. and other developed countries from 1976 through 2001 to determine: 1) the types of interventions studied; 2) whether they cover diseases and conditions with the highest burden; and, 3) to what extent they have covered leading health concerns defined by the Healthy People 2010 report. Data and Methods. We compared rankings of the most common diseases covered by the CUAs to rankings of U.S. disease burden. We also examined the extent to which CUAs covered key Healthy People 2010 priorites. Results. CUAs have focused mostly on pharmaceuticals (40%) and surgical procedures (16%). When compared to leading causes of DALYs, the data show overrepresentation of CUAs in cerebrovascular disease, diabetes, breast cancer, and HIV/AIDS, and underrepresentation in depression and bipolar disorder, injuries, and substance abuse disorders. Few CUAs have targeted Healthy People 2010 areas, such as physical activity. Conclusions. Published CUAs are associated with burden measures, but have not covered certain important health problems. These discrepancies do not alone indicate that society has been targeting resources for research inefficiently, but they do suggest the need to formalize the question of where each CUA research dollar might do the most good.

Economic evaluations conducted alongside randomised controlled trials enable analysis of detailed, patient level data on efficacy, cost, and quality of life in a controlled setting. They can provide timely and reliable assessments of value for money, to inform decisions on coverage and reimbursement.1–3 The BMJ recently decided to consider trial based economic evaluations for publication only if the clinical results are submitted to the journal as well.4 We assessed the extent to which cost utility analyses are conducted alongside trials, estimated the time lag between the publication of trials' clinical and economic results, and compared the characteristics of journals publishing the clinical trial data and the cost utility analyses. We conducted a systematic search for original English language cost utility analyses published in 1976-2001 by using Medline and other electronic databases. Two readers independently reviewed each study and came to a consensus on whether the analysis was conducted alongside a trial (data on both efficacy and resource use from the trial were used for the analysis). We …