When does quality-adjusting life-years matter in cost-effectiveness analysis?
When does quality-adjusting life-years matter in cost-effectiveness analysis?
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DOI：
10.1002/hec.853
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发表时间：
2004-05-01
期刊：
影响因子：
2.1
通讯作者：
Neumann, PJ
中科院分区：
文献类型：
--
作者：
Chapman, RH;Berger, M;Neumann, PJ
目的：本文探讨的影响，生活质量的调整成本效益分析，通过比较已发表的研究，报告了每（未经调整）的生命年和每质量调整的生命年为同一intervention.Methods的增量成本：一个系统的文献检索确定了228个原始的成本效用分析发表于1998年之前。其中63项分析（173个比率对）报告了同一干预措施的成本/LY和成本/QALY比率，从中我们计算了中位数和平均值，比率之间的差异（成本/LY减去成本/ QALY）和比率倒数之间的差异，以及成本/LY占相应成本/QALY比率的百分比。我们还使用等级顺序相关性比较了这些比率，并评估了质量调整导致比率跨越广泛使用的成本-效果阈值20000美元、50000美元和100000美元/QALY或LY的频率。平均比值为69100美元/LY和103100美元/QALY，相应的中位数为24600美元/LY和20400美元/QALY。比率之间的平均差异约为-34300美元（中位数差异：1300美元），60%的比率对的差异为10000美元/年或更少。倒数之间的平均差异为59（QA）LYs每百万美元（中位数：2.1）。比率类型之间的斯皮尔曼等级顺序相关为0.86（p
Purpose: This paper investigates the impact of quality-of-life adjustment on cost-effectiveness analyses, by comparing ratios from published studies that have reported both incremental costs per (unadjusted) life-year and per quality-adjusted life-year for the same intervention.Methods: A systematic literature search identified 228 original cost-utility analyses published prior to 1998. Sixty-three of these analyses (173 ratio pairs) reported both cost/LY and cost/QALY ratios for the same intervention, from which we calculated medians and means, the difference between ratios (cost/LY minus cost/ QALY) and between reciprocals of the ratios, and cost/LY as a percentage of the corresponding cost/QALY ratio. We also compared the ratios using rank-order correlation, and assessed the frequency with which quality-adjustment resulted in a ratio crossing the widely used cost-effectiveness thresholds of $20000, $50000, and $100000/QALY or LY.Results: The mean ratios were $69100/LY and $103100/QALY, with corresponding medians of $24600/LY and $20400/QALY. The mean difference between ratios was approximately -$34300 (median difference: $1300), with 60% of ratio pairs differing by $10000/year or less. Mean difference between reciprocals was 59 (QA)LYs per million dollars (median: 2.1). The Spearman rank-order correlation between ratio types was 0.86 (p