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Comparative effectiveness and cost-effectiveness analyses frequently agree on value.

Henry A Glick1, Sean McElligott2, Mark V Pauly3

  • 1Henry A. Glick is a professor of medicine in the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, in Philadelphia.

Health Affairs (Project Hope)
|May 6, 2015
PubMed
Summary

The Patient-Centered Outcomes Research Institute (PCORI) faces challenges in promoting cost-effective treatments due to ACA restrictions. Disagreements between treatment effectiveness and cost-effectiveness analyses occur in 19% of studies, impacting healthcare value.

Keywords:
Cost of Health CareFinancing Health CareHealth EconomicsHealth ReformQuality Of Care

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Area of Science:

  • Health Services Research
  • Health Economics
  • Comparative Effectiveness Research

Background:

  • The Patient-Centered Outcomes Research Institute (PCORI) was established by the Affordable Care Act (ACA) to advance evidence-based treatments.
  • ACA provisions restrict the use of cost-effectiveness analysis thresholds and quality-adjusted life-years (QALYs) in PCORI studies, complicating evidence-based decision-making for treatments with incremental benefits at higher costs.

Purpose of the Study:

  • To assess the frequency of disagreement between treatment effectiveness and cost-effectiveness analyses.
  • To understand how often limitations on cost-effectiveness analysis in PCORI studies may hinder efficient cost containment.

Main Methods:

  • Analysis of the largest available database comparing treatment effectiveness and cost-effectiveness.
  • Examination of disagreement rates across various cost-effectiveness thresholds defining good value.

Main Results:

  • Disagreement between the more effective and cost-effective treatment occurred in 19% of studies under benchmark assumptions.
  • Musculoskeletal interventions were more likely to show disagreement, while surgical interventions, secondary prevention, and industry-funded studies were less likely.

Conclusions:

  • Restrictions on cost-effectiveness analysis in PCORI studies may limit efficient cost containment.
  • Understanding disagreement patterns is crucial for optimizing healthcare value and evidence-based treatment selection.