What Is the Price of Life and Why Doesn't It Increase at the Rate of Inflation?

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Archives of Internal Medicine (Impact Factor: 17.33). 08/2003; 163(14):1637-41. DOI: 10.1001/archinte.163.14.1637
Source: PubMed
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Available from: Richard A Hirth, Oct 21, 2015
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    • "QALYs were calculated based on changes in utilities as described above, making the assumption that the effect of the intervention persisted for six months. The widely-used value of $50,000 per QALY was used to judge the intervention’s cost effectiveness, although we note that values ranging up to $100,000 per QALY have been used in other studies and that other authorities have argued that the actual cost per QALY may be higher when it is evaluated in the context of the cost of other interventions commonly paid for by third party payers [48,49]. "
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    ABSTRACT: High levels of adherence to medications for HIV infection are essential for optimal clinical outcomes and to reduce viral transmission, but many patients do not achieve required levels. Clinician-delivered interventions can improve patients’ adherence, but usually require substantial effort by trained individuals and may not be widely available. Computer-delivered interventions can address this problem by reducing required staff time for delivery and by making the interventions widely available via the Internet. We previously developed a computer-delivered intervention designed to improve patients’ level of health literacy as a strategy to improve their HIV medication adherence. The intervention was shown to increase patients’ adherence, but it was not clear that the benefits resulting from the increase in adherence could justify the costs of developing and deploying the intervention. The purpose of this study was to evaluate the relation of development and deployment costs to the effectiveness of the intervention. Costs of intervention development were drawn from accounting reports for the grant under which its development was supported, adjusted for costs primarily resulting from the project’s research purpose. Effectiveness of the intervention was drawn from results of the parent study. The relation of the intervention’s effects to changes in health status, expressed as utilities, was also evaluated in order to assess the net cost of the intervention in terms of quality adjusted life years (QALYs). Sensitivity analyses evaluated ranges of possible intervention effectiveness and durations of its effects, and costs were evaluated over several deployment scenarios. The intervention’s cost effectiveness depends largely on the number of persons using it and the duration of its effectiveness. Even with modest effects for a small number of patients the intervention was associated with net cost savings in some scenarios and for durations greater than three months and longer it was usually associated with a favorable cost per QALY. For intermediate and larger assumed effects and longer durations of intervention effectiveness, the intervention was associated with net cost savings. Computer-delivered adherence interventions may be a cost-effective strategy to improve adherence in persons treated for HIV. Trial registration identifier NCT01304186.
    Full-text · Article · Feb 2013 · BMC Medical Informatics and Decision Making
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    • "( Maciosek et al . , 2006 ) . From a population health perspective , most studies find that screening costs anywhere from $ 10 , 000 to $ 25 , 000 per year of life saved as compared to no screening ( Pignone et al . , 2002 ) . This is significantly less than the acceptable threshold of effectiveness ( $ 50 , 000 or less per year of life gained ) ( Ubel et al . , 2003 ) ."
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    ABSTRACT: Colorectal cancer (CRC) is the third most deadly cancer in the United States. While there are several risk factors associated with the development of CRC, the most effective way to prevent CRC deaths is to promote regular screening. Despite strong evidence for the cost effectiveness of screening, compliance with recommended screenings is very low. This paper investigates the impact of mandated insurance coverage for CRC screening on CRC screening rates using a sample of insured adults from the Behavioral Risk Factor Surveillance Survey (BRFSS) from 2001 to 2008. To date, 34 states have mandated private health insurance coverage of colorectal screening. These mandates should reduce the cost of screening for some but not all privately insured patients. We find no evidence that mandates increased screening among males age 50 to 64 overall, though we do find weak evidence that mandates may have increased endoscopic only screening rates among females. However, these effects seem to be driven by a decline in endoscopic only screening among older women that is not observed in younger women. For both men and women, we find little evidence that mandates decreased the fraction of individuals who obtained no recent CRC screening.
    Full-text · Article · Dec 2011 · Health Economics
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    • "The uncertainty of threshold levels creates some controversies. Although the threshold of US$ 50 000 or US$ 100 000 per QALY is widely used, Ubel et al. (2003) pointed out that inflation was not considered in that threshold. If the high range of the threshold was determined to be US$ 100 000 in 1982, it is not reasonable that the same value continues to be adopted until the present time. "
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    ABSTRACT: Although the threshold of cost effectiveness of medical interventions is thought to be 20 000- 30 000 UK pounds in the UK, and $50 000-$100 000 in the US, it is well known that these values are unjustified, due to lack of explicit scientific evidence. We measured willingness-to-pay (WTP) for one additional quality-adjusted life-year gained to determine the threshold of the incremental cost-effectiveness ratio. Our study used the Internet to compare WTP for the additional year of survival in a perfect status of health in Japan, the Republic of Korea (ROK), Taiwan, Australia, the UK, and the US. The research utilized a double-bound dichotomous choice, and analysis by the nonparametric Turnbull method. WTP values were JPY 5 million (Japan), KWN 68 million (ROK), NT$ 2.1 million (Taiwan), 23 000 UK pounds (UK), AU$ 64 000 (Australia), and US$ 62 000 (US). The discount rates of outcome were estimated at 6.8% (Japan), 3.7% (ROK), 1.6% (Taiwan), 2.8% (UK), 1.9% (Australia), and 3.2% (US). Based on the current study, we suggest new classification of cost-effectiveness plane and methodology for decision making.
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