Marcus Shaker1, Matthew Greenhawt2. 1. Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, New Hampshire; Dartmouth Geisel School of Medicine, Hanover, New Hampshire. Electronic address: marcus.s.shaker@hitchcock.org. 2. Children's Hospital Colorado, University of Colorado School of Medicine, Section of Allergy and Immunology, Food Challenge and Research Unit, Aurora, Colorado.
Abstract
OBJECTIVE: To provide a cost-effectiveness primer for the practicing allergist. DATA SOURCES: Articles assessing use of decision analysis and cost-effective healthcare delivery. STUDY SELECTIONS: A narrative review detailing approaches to incorporate evidence based medicine into individualized patient-centered cost-effective practice. RESULTS: Resources in medicine are finite and it has been estimated that more than 30% of healthcare spending is directed toward low-value care. Insurers and government agencies are increasingly looking to maximize health value. Cost-effective analyses (CEA) is a complex valuation that grades health outcomes and economic benefits of a specific aspect of clinical care over a particular time horizon. In the US, therapies are generally considered cost-effective at ceilings between $50,000 - $150,000 per QALY. Critical components of CEA include model development to accurately represent clinical decisions and outcomes, evidence-based inputs, appropriate sensitivity analyses, and clarity in selecting the target population, perspective, comparators, time horizon, discount rate, and health outcomes. CEA can better inform trade-offs in patient care and add clarity in the translation of evidence to medical recommendations. Future research is likely to provide a more complete understanding of variation across population health state utilities for allergic conditions to more accurately reflect quality adjusted life years for patients with allergies. CONCLUSION: Viewing healthcare options through an economic lens has become the standard of care across the United States and internationally, whether mandated through government agencies or third party payers. Decision analysis with cost-utility models can provide a useful perspective for both individual practice and public health.
OBJECTIVE: To provide a cost-effectiveness primer for the practicing allergist. DATA SOURCES: Articles assessing use of decision analysis and cost-effective healthcare delivery. STUDY SELECTIONS: A narrative review detailing approaches to incorporate evidence based medicine into individualized patient-centered cost-effective practice. RESULTS: Resources in medicine are finite and it has been estimated that more than 30% of healthcare spending is directed toward low-value care. Insurers and government agencies are increasingly looking to maximize health value. Cost-effective analyses (CEA) is a complex valuation that grades health outcomes and economic benefits of a specific aspect of clinical care over a particular time horizon. In the US, therapies are generally considered cost-effective at ceilings between $50,000 - $150,000 per QALY. Critical components of CEA include model development to accurately represent clinical decisions and outcomes, evidence-based inputs, appropriate sensitivity analyses, and clarity in selecting the target population, perspective, comparators, time horizon, discount rate, and health outcomes. CEA can better inform trade-offs in patient care and add clarity in the translation of evidence to medical recommendations. Future research is likely to provide a more complete understanding of variation across population health state utilities for allergic conditions to more accurately reflect quality adjusted life years for patients with allergies. CONCLUSION: Viewing healthcare options through an economic lens has become the standard of care across the United States and internationally, whether mandated through government agencies or third party payers. Decision analysis with cost-utility models can provide a useful perspective for both individual practice and public health.