Does Medicare Have an Implicit Cost-Effectiveness Threshold?

Chambers, James D.; Neumann, Peter J.; Buxton, Martin

doi:10.1177/0272989x10371134

Cited by 55 publications

(45 citation statements)

References 47 publications

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“…Through the implementation of a 15/25 tiered allocation system, we could increase the lifeyears benefit from transplant by 551 at a cost of less than $20 000 per life year saved. This compares favorably with the incremental costs effectiveness of procedures accepted by CMS for Medicare coverage, which range from <$50 000 to more than $100 000 per life year saved (27). In general, a ratio less than $50 000-$100 000 per QALY is considered cost effective in the US (28,29).…”

Section: Economics Of Liver Allocationmentioning

confidence: 86%

The Economic Implications of Broader Sharing of Liver Allografts

Axelrod

Gheorghian

Schnitzler

et al. 2011

American Journal of Transplantation

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Liver transplantation has evolved over the past four decades into the most effective method to treat endstage liver failure and one of the most expensive medical technologies available. Accurate understanding of the financial implication of recipient severity of illness is crucial to assessing the economic impact of allocation policies. A novel database of linked clinical data from the Organ Procurement and Transplantation Network with cost accounting data from the University HealthSystem Consortium was used to analyze liver transplant costs for 15 813 liver transplants. This data was then utilized to consider the economic impact of alternative allocation systems designed to increase sharing of liver allografts using simulation results. Transplant costs were strongly associated with recipient severity of illness as assessed by the MELD score (p < 0.0001); however, this relationship was not linear. Simulation analysis of the reallocation of livers from low MELD patients to high MELD using a two-tiered regional sharing approach (MELD 15/25) resulted in 88 fewer deaths annually at estimated cost of $17 056 per quality-adjusted life-year saved. The results suggest that broader sharing of liver allografts offers a cost-effective strategy to reduce the mortality from end stage liver disease.

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Section: Economics Of Liver Allocationmentioning

confidence: 86%

The Economic Implications of Broader Sharing of Liver Allografts

Axelrod

Gheorghian

Schnitzler

et al. 2011

American Journal of Transplantation

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“…This was eventually abandoned because of political and legal challenges [11]. Other US health technology assessment organizations also resisted using economic evaluations, along with some economists in the USA and Canada, seeing it cynically as a means of advancing commercial interests and a gizmo-besotted medical profession [12][13][14].…”

Section: Pharmaceuticalsmentioning

confidence: 99%

“…However, there is some evidence that it plays a small role in coverage decisions [21]. Medicare Prescription Drug Plans, for example, have employed many techniques for restricting high-cost (and high-ICER) drugs, from tiered co-payments to prior authorization, and step therapy (using more costeffective drugs first) [11,22]. Despite this limited use of economic evaluation, it is evident that high-quality clinical evidence of clear (even if relatively small) benefit is a much stronger predictor of positive coverage decisions than cost effectiveness in both countries [15,21].…”

Section: Pharmaceuticalsmentioning

confidence: 99%

How do Economic Evaluations Inform Health Policy Decisions for Treatment and Prevention in Canada and the United States?

Husereau

Culyer

Neumann

et al. 2014

Appl Health Econ Health Policy

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Canadian and US health systems have often been characterized as having vastly different approaches to the financing and delivery of healthcare, with Canada portrayed as more reliant on rationing based on costs. In this article, we examine the similarities and differences between the two countries, the evolution and current role of health economic evaluation, and the roles played by health economists. We suggest both countries have similarly used economic evaluation to a limited extent for drug and immunization decisions, with variability in use more of a reflection of the incompleteness of both systems and their inherent institutional barriers rather than political ideology.

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“…CMS is currently prevented by statute from considering cost when determining what is appropriate care for Medicare beneficiaries (20), and analyses show that a substantial number of Medicare-approved interventions are .$100,000/QALY (21,22). To date, society has been willing to pay for dialysis despite its high ICER.…”

Section: How Will the Government Measure The Value Of Care?mentioning

confidence: 99%

The Coming Fiscal Crisis

Andersen

Friedman

2013

Clinical Journal of the American Society of Nephrology

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SummaryNephrologists in the United States face a very uncertain economic future. The astronomical federal debt and unfunded liability burden of Medicare combined with the aging population will place unprecedented strain on the health care sector. To address these fundamental problems, it is conceivable that the federal government will ultimately institute rationing and other budget-cutting measures to rein in costs of ESRD care, which is generously funded relative to other chronic illnesses. Therefore, nephrologists should expect implementation of cost-cutting measures, such age-based rationing, mandated delayed dialysis and home therapies, compensated organ donation, and a shift in research priorities from the dialysis to the predialysis patient population. Nephrologists also need to recognize that these changes, which are geared toward the population level, may make it more difficult to advocate effectively for the needs of individual patients.

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Does Medicare Have an Implicit Cost-Effectiveness Threshold?

Cited by 55 publications

References 47 publications

The Economic Implications of Broader Sharing of Liver Allografts

The Economic Implications of Broader Sharing of Liver Allografts

How do Economic Evaluations Inform Health Policy Decisions for Treatment and Prevention in Canada and the United States?

The Coming Fiscal Crisis

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