A primer on cost-effectiveness in the allergy clinic

Abstract

CEA is a useful tool to compare management paradigms and differentiate high from low value care strategies. An understanding of low value healthcare is important across all areas of medicine to minimize waste and leverage societal opportunity costs to optimize population health. Policy makers and payers look to systematic reviews and CEA to define best-practice strategies, and an understanding of the utility and limitations of these analyses is important.

Making the GRADE in anaphylaxis management

“…1,12,13 Cost-effectiveness can be an important aspect of the evidence to recommendation framework, but depending on the balance of other factors, a therapy or strategy may still be considered contextually even if it is not costeffective (often in the setting of shared decision making). 14,15 Equity is considered in the evidence to recommendation framework with specific judgments made with regard to how recommendations may affect underserved, socioeconomically disadvantaged, and other populations. 16 In a GRADE document, the reader can find these assessments described in an evidence to recommendation framework in which research evidence and additional considerations are summarized to reach recommendations stated as for or against.…”

Achieving the Quadruple Aim to deliver value-based allergy care in an ever-evolving health care system

“…Cost-effective care defines a care pathway option that, relative to other choices and strategies for management, provides superior health outcomes at the lowest cost, thus providing an objective measure of the value of a health care dollar being spent. 35,36 Cost-effectiveness is a predominant feature of socialized/rationed healthcare systems like the United Kingdom National Health Service or single-payer systems that exist in most other countries but has only recently become a concern in the United States given that the health care system has seen a transformation in the payment reimbursement system in the past 40 years. Cost-effectiveness analyses use inputs that integrate medical evidence, management efficacy for the patient, and the cost impact (explored at a patient, payer, or societal level) over a specific time-horizon.…”

“…Cost-effectiveness outcomes are ordinarily focused on the QALY, which represents a year of perfect health relative to the condition of interest, and revolve around a spending threshold to gain a single QALY. 35 The quality-adjusted life year is important because it provides context to the quality of the time spent, and time without disease is worth more than time with the disease. 35 The threshold is often debated and somewhat controversial, but in the United States is typically $100,000/QALY (or $10 million per death prevented), derived in the 1970s from Medicare coverage of end-stage renal disease, and a societal standard for willingness to pay for a particular medical treatment (Figure 1).…”

“…35 The quality-adjusted life year is important because it provides context to the quality of the time spent, and time without disease is worth more than time with the disease. 35 The threshold is often debated and somewhat controversial, but in the United States is typically $100,000/QALY (or $10 million per death prevented), derived in the 1970s from Medicare coverage of end-stage renal disease, and a societal standard for willingness to pay for a particular medical treatment (Figure 1). 35 Interventions that fall under this threshold are considered cost-effective.…”

What the COVID-19 Pandemic Can Teach Us About Resource Stewardship and Quality in Health Care

“…However, the balance of reducing the risk of transmitting COVID-19 to individuals and populations, decreased rate of overdiagnosis and overtreatment, and cost-reductions of nonessential care may balance any potential harms, and has the potential to result in greater ability to deliver cost-effective care in many circumstances. [6][7][8]…”