Grosse SDAssessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Exp Rev Pharmacoecon Outcomes Res 8: 165-178

National Center on Birth Defects & Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Raod NE, Atlanta, GA 30333, USA. .
Expert Review of Pharmacoeconomics & Outcomes Research (Impact Factor: 1.67). 04/2008; 8(2):165-78. DOI: 10.1586/14737167.8.2.165
Source: PubMed


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.

119 Reads
  • Source
    • "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 "
    [Show abstract] [Hide abstract]
    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
    Full-text · Article · Mar 2015 · British Journal of Cancer
  • Source
    • "Assuming that health care resources are limited, cost-effectiveness studies thus enables that more patients can achieve clinical improvement and increased quality of life (Drummond, Sculpher, Torrence, O'Brien, & Stoddart, 2005). There is no consensus regarding the definition of a cost-effective treatment, but in the western world, a treatment that can generate an additional quality adjusted life year (QALY) at a cost below 50 000 USD is generally considered cost-effective (Grosse, 2008). ICBT has been shown to be a highly cost-effective treatment for a range of clinical disorders (Hedman et al. 2013; Hedman et al. 2011) "
    [Show abstract] [Hide abstract]
    ABSTRACT: Obsessive-compulsive disorder (OCD) is a common and disabling disorder. Although evidence-based psychological treatments exists, such as cognitive behavior therapy (CBT), the cost-effectiveness of CBT has not been properly investigated. In this trial, we used health economic data from a recently conducted randomized controlled trial, where 101 OCD patients were allocated to either internet-based CBT (ICBT) or control condition (online support therapy). We analyzed treatment effectiveness in relation to costs, using both a societal- (including all direct and indirect costs) and a health care unit perspective (including only the direct treatment costs). Bootstrapped net benefit regression analyses were also conducted, comparing the difference in costs and effects between ICBT and control condition, with different willingness-to-pay scenarios. Results showed that ICBT produced one additional remission for an average societal cost of $931 and this figure was even lower ($672) when narrowing the perspective to treatment costs only. The cost-utility analysis also showed that ICBT generated one additional QALY to an average price of $7186 from a societal perspective and $4800 when just analyzing the treatment costs. We conclude that ICBT is a cost-effective treatment and the next step in this line of research is to compare the cost-effectiveness of ICBT with face-to-face CBT.
    Full-text · Article · Jan 2015 · Journal of Obsessive-Compulsive and Related Disorders
  • Source
    • "Although multilevel, multicomponent programs may be effective in changing clinical outcomes, their costeffectiveness is a concern if wide-scale implementation is required to serve the growing number of patients with diabetes. Researchers sometimes use a cost of $50,000/ life year or $50,000/quality-adjusted life year (QALY) as a benchmark or " willingness to pay " for considering an intervention to be cost-effective or not, although the conceptual basis for choosing such a benchmark is controversial (Glick, Doshi, Sonnad, & Polsky, 2007; Grosse, 2008; Woolf, 2009). One study estimated the incremental cost-effectiveness of improving diabetes care with the Health Disparities Collaboratives in community health centers and found an incremental cost-effectiveness ratio of $33,386/QALY (Huang et al., 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Alliance programs implemented multilevel, multicomponent programs inspired by the chronic care model and aimed at reducing health and health care disparities for program participants. A unique characteristic of the Alliance programs is that they did not use a fixed implementation strategy common to programs using the chronic care model but instead focused on strategies that met local community needs. Using data provided by the five programs involved in the Alliance, this evaluation shows that of the 1,827 participants for which baseline and follow-up data were available, the program participants experienced significant decreases in hemoglobin A1c and blood pressure compared with a comparison group. A significant time by study group interaction was observed for hemoglobin A1c as well. Over time, more program participants met quality indicators for hemoglobin A1c and blood pressure. Those participants who attended self-management classes and experienced more resources and support for self-management attained more benefit. In addition, program participants experienced more diabetes competence, increased quality of life, and improvements in diabetes self-care behaviors. The cost-effectiveness of programs ranged from $23,161 to $61,011 per quality-adjusted life year. In sum, the Alliance programs reduced disparities and health care disparities for program participants.
    Preview · Article · Nov 2014 · Health Promotion Practice
Show more