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Med Care. 2008 Apr;46(4):349-56. doi: 10.1097/MLR.0b013e31815c31a7.

What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule?

Author information

1
Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. Ronald.braithwaite@va.gov

Abstract

BACKGROUND:

In the United States, $50,000 per Quality-Adjusted Life-Year (QALY) is a decision rule that is often used to guide interpretation of cost-effectiveness analyses. However, many investigators have questioned the scientific basis of this rule, and it has not been updated.

METHODS:

We used 2 separate approaches to investigate whether the $50,000 per QALY rule is consistent with current resource allocation decisions. To infer a lower bound for the decision rule, we estimated the incremental cost-effectiveness of recent (2003) versus pre-"modern era" (1950) medical care in the United States. To infer an upper bound for the decision rule, we estimated the incremental cost-effectiveness of unsubsidized health insurance versus self-pay for nonelderly adults (ages 21-64) without health insurance. We discounted both costs and benefits, following recommendations of the Panel on Cost-Effectiveness in Health and Medicine.

RESULTS:

Our base case analyses suggest that plausible lower and upper bounds for a cost-effectiveness decision rule are $183,000 per life-year and $264,000 per life-year, respectively. Our sensitivity analyses widen the plausible range (between $95,000 per life-year saved and $264,000 per life-year saved when we considered only health care's impact on quantity of life, and between $109,000 per QALY saved and $297,000 per QALY saved when we considered health care's impact on quality as well as quantity of life) but it remained substantially higher than $50,000 per QALY.

CONCLUSIONS:

It is very unlikely that $50,000 per QALY is consistent with societal preferences in the United States.

PMID:
18362813
DOI:
10.1097/MLR.0b013e31815c31a7
[Indexed for MEDLINE]

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