Cost-Effectiveness Analysis 2.0.

نویسندگان

  • Peter J Neumann
  • Gillian D Sanders
چکیده

n engl j med 376;3 nejm.org January 19, 2017 C analysis in U.S. health care seems poised for a second act of sorts. Although it has never actually gone away, efforts to apply it have encountered resistance, and the federal government and some health care organizations have sometimes prohibited its use or relegated it to a minor role. But several developments are helping to recharge the field. One is the embrace of its methods by prominent groups that are using it to measure and communicate the value of new drugs and other interventions. Another is the publication of new guidelines for such analysis from a national panel that is updating recommendations for the field from 1996.1-3 Cost-effectiveness analyses reveal the trade-offs involved in choosing among alternative interventions, with the goal of obtaining the most health possible for the available resources. Such analyses help define and illuminate the potential health benefits lost when the best alternative is not selected. Researchers have conducted cost-effectiveness analyses on a wide range of topics. Some organizations, such as the Advisory Committee for Immunization Practices, which establishes national immunization policy recommendations on behalf of the Centers for Disease Control and Prevention, have used these analyses in their deliberations. The Medicare program, however, does not consider cost-effectiveness when deciding whether to cover and pay for new therapies, though it has made exceptions for certain preventive services. The Affordable Care Act forbids the Patient Centered Outcomes Research Institute from considering ratios of cost per quality-adjusted life-year (QALY), the usual way of presenting the results of cost-effectiveness analysis, as thresholds in establishing which health care services are cost-effective or recommended. Reasons for the opposition to costeffectiveness analysis are multifaceted and reflect mistrust of the underlying methods or the motives of the parties conducting the analyses, or a desire on the part of many Americans to deny or downplay the underlying problem of resource scarcity in health care.3 Developments over the past year may signal a shift, however. In 2014, the American College of Cardiology and the American Heart Association released new guidance for developers of clinical practice guidelines emphasizing the importance of “value” considerations in such guidelines and have chosen to highlight ranges of cost-per-QALY thresholds as complements to traditional grading methods based on the strength of the clinical evidence.4 At the same time, the Institute for Clinical and Economic Review, a nonprofit organization that uses cost-effectiveness analysis as part of a process for assessing the value of drugs and other technologies, has received widespread attention for a series of reports on therapies for heart failure, multiple myeloma, and other conditions.5 Other organizations, such as the American Society for Clinical Oncology, Memorial Sloan Kettering Cancer Center, and the National Comprehensive Cancer Network, have released their own value frameworks that examine components such as clinical benefit, adverse events, and quality of life, though they do not aggregate these measures into formal cost-effectiveness analyses. Then, in September 2016, the Second Panel on Cost-Effectiveness in Health and Medicine, which we cochaired, published a report revising guidance on various aspects of cost-effectiveness analysis reflecting advances in the field.2,3 A key change pertains to the recommended perspective for analyses. The original panel on costeffectiveness, convened in 1993 by the U.S. Public Health Service, recommended that to improve the quality and comparability of costeffectiveness analyses, analysts should use a “reference case” incorporating a set of standard methodologic practices. It further advised that reference-case analyses should assume a “societal perspective,” reflecting the viewpoint of a decision maker considering the broad allocation of resources across the population. Under such a perspective, the analyst considers all parties affected by the intervention and counts all significant outcomes and costs that f low from it, regardless of who experiences them. Our panel (which was convened by a leadership group that Population Health C st-Effectiv ness Analysis 2.0

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Cost-Effectiveness analysis of malaria diagnosis techniques in patients with suspected malaria in Hormozgan province- 2012

Introduction: Since ancient times Malaria in Iran has been considered as a serious health risk, especially in Hormozgan Province, as no other disease like Malaria has imposed irreparable financial and life losses to the country. Since saving costs in the healthcare sector comes as first priority in most countries, this study aims at launching a cost-effectiveness analysis on malaria diagnosis d...

متن کامل

Cost-effectiveness of rosuvastatin for primary prevention of cardiovascular events according to Framingham Risk Score in patients with elevated C-reactive protein.

CONTEXT The Food and Drug Administration (FDA) recently approved rosuvastatin calcium for prevention of cardiovascular events in patients who have elevated levels of high-sensitivity C-reactive protein (hs-CRP) but not overt hyperlipidemia. The FDA's decision was based primarily on research reported by the JUPITER (Justification for the Use of Statins in Prevention: An Intervention Trial Evalua...

متن کامل

Cost-Effectiveness Analysis of Health Interventions: A Critical Review

Background and Aim: Economic evaluation of health interventions by comparing the relevant costs and benefits will result in optimum allocation of resources and increasing the effectiveness of the health system and, through improving equity and increasing accessibility to health services, will lead to increased effectiveness of the health system. The purpose of this study was to critically evalu...

متن کامل

Economic Evaluation of Infliximab for Treatment of Refractory Ulcerative Colitis in Iran: Cost-Effectiveness Analysis

The aim of this study is to assess cost-effectiveness of infliximab, compared with conventional treatments in patients with moderate to severe Ulcerative Colitis (UC) in Iran. We developed an analytical decision model with a 5-year-time horizon to follow up 1000 hypothetical patients, in order to estimate treatment costs and outcomes. Hypothetical patients, were individuals with moderate to sev...

متن کامل

Cost effectiveness of HMG-CoA reductase inhibitor (statin) treatment related to the risk of coronary heart disease and cost of drug treatment.

OBJECTIVES To estimate the cost effectiveness of statin treatment in preventing coronary heart disease (CHD) and to examine the effect of the CHD risk level targeted and the cost of statins on the cost effectiveness of treatment. DESIGN Cohort life table method using data from outcome trials. MAIN OUTCOME MEASURES The cost per life year gained for lifelong statin treatment at annual CHD eve...

متن کامل

Cost-Effectiveness Analysis of Psoriasis Treatment Modalities in Malaysia

Background There is limited evidence detailing the cost-effectiveness of psoriasis treatments in the Asian region. Therefore, this study is aimed to evaluate the cost-effectiveness of 3 psoriasis treatments tailored for moderate to severe psoriasis, namely topical and phototherapy (TP), topical and systemic (TS), and topical and biologic (TB) regimens, respectively. Me...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • The New England journal of medicine

دوره 376 3  شماره 

صفحات  -

تاریخ انتشار 2017