What does the value of modern medicine say about the $50,000 per Quality-Adjusted Life-Year decision rule?
What does the value of modern medicine say about the $50,000 per Quality-Adjusted Life-Year decision rule?
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DOI：
10.1097/mlr.0b013e31815c31a7
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发表时间：
2008-04-01
期刊：
影响因子：
3
通讯作者：
Roberts, Mark S.
中科院分区：
文献类型：
--
作者：
Braithwaite, R. Scott;Meltzer, David O.;Roberts, Mark S.
背景：在美国，每个质量调整后的终身年度（QALY）50,000美元是一项决策规则，通常用于指导对成本效益分析的解释。但是，许多调查人员质疑该规则的科学基础，并且尚未进行更新。方法：我们使用了两种单独的方法来研究每个QALY规则50,000美元是否与当前的资源分配决策一致。为了推断决策规则的下限，我们估计了美国最近（2003年）与“现代时代”（1950年）的医疗保健的增量成本效益。为了推断决策规则的上限，我们估计了无补贴的健康保险的增量成本效益，而没有健康保险的非高级成年人（21-64岁）的自付额（21-64岁）。根据小组对健康和医学的成本效益的建议，我们均折现了成本和收益。研究：我们的基本案例分析表明，成本效益决策规则的合理下限和上限为每年183,000美元，$ 264,000分别为每个生命年。我们的敏感性分析扩大了合理的范围（每年节省的$ 95,000介于$ 95,000介于$ 264,000之间，当我们仅考虑医疗保健对寿命的影响时，每年节省了264,000美元，而每QALY节省的$ 109,000在我们考虑保存的QALY $ 297,000之间，则在我们考虑使用医疗保健时节省了297,000美元。对质量和寿命的影响），但每个QALY的质量仍然高于50,000美元。结论：不可能很不可能每个QALY $ 50,000与美国的社会偏好一致。
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.