Key Considerations for Cost Effectiveness Thresholds
While putting a price tag on the value of health care services and the life years gained is common in countries including the United Kingdom, Canada and Australia, a number of entities in the United States are using cost effectiveness assessment thresholds (CEA) to determine the value of health care services. Only time will tell if they are isolated cases or part of a growing trend, but in his latest column in the Journal of Comparative Effectiveness Research (JCER), National Pharmaceutical Council Chief Science Officer Robert W. Dubois, MD, PhD, discusses what broad use of CEA might mean for comparative effectiveness researchers and the decision-makers who apply the research.
Dr. Dubois’ article, “Cost Effectiveness Thresholds in the United States: Are they coming? Are they already here?” notes that CEA, and the resource allocation that comes with them, have generally been considered out of sync with the U.S. health care environment and population values. However, with growing concerns surrounding rising health care costs, there are a number of U.S. organizations not only integrating CEA into health intervention assessments, but in several cases, using quality adjusted life years (QALYs) as the basis for their methods to assess both the cost of the intervention and cost offsets (such as reduced hospitalization).
What does this shift in the U.S. mean for researchers and the decision makers who apply these assessments to coverage and treatment decisions? Dr. Dubois highlights four important considerations:
- QALYs have known limitations – Further research is necessary to learn how to address these limitations or develop an alternative to the QALY.
- CEA thresholds assume all patients are the same – In real-world care, treatments lead to varying degrees of benefits for patients. Policy decisions should be thoughtful in examining subgroups, such as biologic, disease stage/severity and personal characteristics.
- CEA doesn’t assess all benefits important to patients – Other factors—such as potential for long term survival, ease of use or lack of other treatment options—matter to patients, yet may be left out of assessments.
- Agreement is lacking on which costs to include in CEA – Direct costs such as drug pricing, diagnostics and hospitalizations are part of the equation, but economic benefits such as improved wellbeing, better daily functioning, reduced need for caregiver assistance or increased work productivity need further examination and societal discussion to address.
Read the full text online at the JCER website.