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Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold
1National Center on Birth Defects & Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Raod NE, Atlanta, GA 30333, USA. sgrosse@cdc.gov.
Abstract:
Cost-effectiveness analyses, particularly in the USA, commonly use a figure of $50,000 per life-year or quality-adjusted life-year gained as a threshold for assessing the cost-effectiveness of an intervention. The history of this practice is ill defined, although it has been linked to the end-stage renal disease kidney dialysis cost-effectiveness literature from the 1980s. The use of $50,000 as a benchmark for assessing the cost-effectiveness of an intervention first emerged in 1992 and became widely used after 1996. The appeal of the $50,000 figure appears to lie in the convenience of a round number rather than in the value of renal dialysis. Rather than arbitrary thresholds, estimates of willingness to pay and the opportunity cost of healthcare resources are needed.
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