Medicare and cost-effectiveness analysis.

The Medicare program has been a notable holdout in the global movement toward the use of cost-effectiveness analysis to inform health care decisions. Unlike the reimbursement authorities in Canada and Australia, and in many countries in Europe, Medicare officials do not formally consider cost-effectiveness when determining the coverage of new medical interventions, even as they also confront ever-growing worries about the program’s fiscal solvency.1,2 In this article, we discuss the road ahead for cost-effectiveness analysis in the Medicare program. We examine resistance to its application, opportunities for its use, and ways in which the United States might move beyond its anxiety about the use of this technique.