Dan Greenberg1, Peter J Neumann. 1. The Center for the Evaluation of Value and Risk in Health, The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. dangr@bgu.ac.il
Abstract
AIMS: We investigated the extent to which adjusting for health-related quality of life (HRQoL) alters incremental cost per life-year gained ratios, and the implications for reimbursement decisions. METHODS: We identified all cancer-related interventions in the Tufts Medical Center Cost-Effectiveness Analysis Registry in which both a cost/quality-adjusted life-year (QALY) and a cost/life-year ratio were reported in the same study. We assessed the ordinal relationship between these ratios and analyzed the extent to which using a cost/QALY rather than a cost/life-year ratio would potentially yield different reimbursement decisions. RESULTS: The rank-order correlation between cost/life-year and cost/QALY ratio pairs was 0.917 (p < 0.0001). In 78.8% of comparisons, both cost/QALY and cost/life-year ratios were below a prespecified threshold (e.g., US$50,000 per QALY or life-year). Adjusting for HRQoL resulted in a higher ratio such that it crossed a prespecified threshold in 18.6% of interventions. The data suggest that adjusting life-years for HRQoL does not substantively affect cost per life-year ratios for the vast majority of cancer-related interventions. CONCLUSION: Our analysis implies that the method used for HRQoL adjusting or even HRQoL adjusting at all does not matter for most reimbursement decisions on life-saving interventions. The results could differ for interventions that have large impacts on patients' HRQoL compared with the impact on survival.
AIMS: We investigated the extent to which adjusting for health-related quality of life (HRQoL) alters incremental cost per life-year gained ratios, and the implications for reimbursement decisions. METHODS: We identified all cancer-related interventions in the Tufts Medical Center Cost-Effectiveness Analysis Registry in which both a cost/quality-adjusted life-year (QALY) and a cost/life-year ratio were reported in the same study. We assessed the ordinal relationship between these ratios and analyzed the extent to which using a cost/QALY rather than a cost/life-year ratio would potentially yield different reimbursement decisions. RESULTS: The rank-order correlation between cost/life-year and cost/QALY ratio pairs was 0.917 (p < 0.0001). In 78.8% of comparisons, both cost/QALY and cost/life-year ratios were below a prespecified threshold (e.g., US$50,000 per QALY or life-year). Adjusting for HRQoL resulted in a higher ratio such that it crossed a prespecified threshold in 18.6% of interventions. The data suggest that adjusting life-years for HRQoL does not substantively affect cost per life-year ratios for the vast majority of cancer-related interventions. CONCLUSION: Our analysis implies that the method used for HRQoL adjusting or even HRQoL adjusting at all does not matter for most reimbursement decisions on life-saving interventions. The results could differ for interventions that have large impacts on patients' HRQoL compared with the impact on survival.
Authors: Nalin Payakachat; J Mick Tilford; Karen A Kuhlthau; N Job van Exel; Erica Kovacs; Jayne Bellando; Jeffrey M Pyne; Werner B F Brouwer Journal: Autism Res Date: 2014-09-25 Impact factor: 5.216
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