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When does quality-adjusting life-years matter in cost-effectiveness analysis?
Richard H Chapman1, Marc Berger, Milton C Weinstein
1Program on the Economic Evaluation of Medical Technology, Harvard Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts 02115, USA. pneumann@hsps.harvard.edu
Health Economics
|May 6, 2004
Summary
Quality adjustment in cost-effectiveness analyses often does not substantially change results, suggesting sensitivity analyses may suffice. Careful consideration of data collection costs versus benefits is crucial for utility weights.
Area of Science:
- Health Economics
- Pharmacoeconomics
- Decision Science
Background:
- Cost-effectiveness analysis (CEA) is vital for healthcare resource allocation.
- Quality-adjusted life-year (QALY) is a common metric, incorporating quality of life.
- Comparing cost per life-year (LY) and cost per QALY is essential.
Purpose of the Study:
- To investigate the impact of quality-of-life adjustment on CEA.
- To compare cost-effectiveness ratios using unadjusted life-years (LY) versus quality-adjusted life-years (QALY).
Main Methods:
- Systematic literature search of cost-utility analyses published before 1998.
- Identified 63 analyses reporting both cost/LY and cost/QALY ratios.
- Calculated medians, means, differences, and rank-order correlations; assessed threshold crossings.
Main Results:
- Mean cost/LY was $69,100, while mean cost/QALY was $103,100.
- Median cost/LY was $24,600, and median cost/QALY was $20,400.
- Quality adjustment shifted cost-effectiveness ratios across thresholds in 6-8% of cases.
Conclusions:
- Quality adjustment does not always substantially alter intervention cost-effectiveness.
- Sensitivity analyses with ad hoc or 'off-the-shelf' utility weights may be adequate.
- Data collection for preference weights requires scrutiny regarding cost-benefit.