Grosse SDAssessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Exp Rev Pharmacoecon Outcomes Res 8: 165-178
ABSTRACT Cost-effectiveness analyses, particularly in the USA, commonly use a figure of $50,000 per life-year or quality-adjusted life-year gained as a threshold for assessing the cost-effectiveness of an intervention. The history of this practice is ill defined, although it has been linked to the end-stage renal disease kidney dialysis cost-effectiveness literature from the 1980s. The use of $50,000 as a benchmark for assessing the cost-effectiveness of an intervention first emerged in 1992 and became widely used after 1996. The appeal of the $50,000 figure appears to lie in the convenience of a round number rather than in the value of renal dialysis. Rather than arbitrary thresholds, estimates of willingness to pay and the opportunity cost of healthcare resources are needed.
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- "In a comprehensive review , Grosse puts the initial mention of the $ 50 000 threshold in 1972 at the initiation of Medicare coverage for patients with end - stage renal disease ; the first article using a cost - effectiveness threshold in 1992 followed by the publication of the first studies using this threshold in 1995 ; and ( informal ) adoption of the threshold between 1996 and 1998 ( Grosse , 2008 "
ABSTRACT: The combination of nab-paclitaxel plus gemcitabine (NAB-P+GEM) has shown superior efficacy over GEM monotherapy in metastatic pancreas cancer (MPC). Independent cost-effectiveness/utility analyses of NAB-P+GEM from the payer perspective have not been conducted for the UK. A Markov model simulating the health outcomes and total costs was developed to estimate the life years gained (LYG) and quality-adjusted life years gained (QALY) and incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR) for patients with MPC in a base case and in a probabilistic (PSA) sensitivity analysis. Total cost included the cost of supportive care medications, administration, chemotherapy, disease monitoring, and adverse reactions; and was discounted at 3.5% per year. A full lifetime horizon and third party payer perspective was chosen. The total cost of NAB-P+GEM was £5466 higher than the cost for GEM. Respectively, LYGs were 0.97 vs 0.79 and QALYs were 0.52 vs 0.45, with ICER of £30 367/LYG and ICUR of £78 086/QALY, confirmed by PSA. The superior survival efficacy of NAB-P+GEM over GEM in the management of MPC is associated with positive cost-effectiveness and cost-utility.British Journal of Cancer advance online publication 19 March 2015; doi:10.1038/bjc.2015.65 www.bjcancer.com.British Journal of Cancer 03/2015; 112(8). DOI:10.1038/bjc.2015.65 · 4.82 Impact Factor
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- "In Italy, at present, there is no indication by policymakers of such a criterion for decision making and this same value might not be deemed appropriate in the future. To better contribute to inform, and potentially change, the current genetic testing practice, we believe that it was still important to compare our results with a value that, although with great limitations , is an internationally established reference. "
ABSTRACT: In the Italian health care system, genetic tests for factor V Leiden and factor II are routinely prescribed to assess the predisposition to venous thromboembolism (VTE) of women who request oral contraception. With specific reference to two subpopulations of women already at risk (i.e., familial history or previous event of VTE), the study aimed to assess whether current screening practices in Italy are cost-effective. Two decisional models accrued costs and quality-adjusted life-years (QALY) annually from the perspective of the National Health Service. The two models were derived from a decision analysis exercise concerning testing practices and consequent prescribing behavior for oral contraception conducted with 250 Italian gynecologists. Health care costs were compiled on the basis of 10-year hospital discharge records and the activities of a thrombosis center. Whenever possible, input data were based on the Italian context; otherwise, the data were taken from the international literature. Current testing practices on women with a familial history of VTE generate an incremental cost-effectiveness ratio of €72,412/QALY, which is well above the acceptable threshold of cost-effectiveness of €40,000 to €50,000/QALY. In the case of women with a previous event of VTE, the most frequently used testing strategy is cost-ineffective and leads to an overall loss of QALY. This study represents the first attempt to conduct a cost-utility analysis of genetic screening practices for the predisposition to VTE in the Italian setting. The results indicate that there is an urgent need to better monitor the indications for which tests for factor V Leiden and factor II are prescribed.Value in Health 09/2013; 16(6):909-21. DOI:10.1016/j.jval.2013.05.003 · 2.89 Impact Factor
Value in Health 09/2013; 16(6):1103-1104. DOI:10.1016/j.jval.2013.06.019 · 2.89 Impact Factor
- "The use of $50,000 as a limit to determine cost-effectiveness was set in the early 1980s, and was used widely after 1996 . Many recent studies have challenged these values by using willingness to pay   . For example, the willingness-to-pay values in Shiroiwa et al.'s  study were £23,000 in the United Kingdom and US $62,000 in the United States. "