Valuing a QALY: review of current controversies

Asim, Oya; Petrou, Stavros

doi:10.1586/14737167.5.6.667

Cited by 16 publications

(13 citation statements)

References 12 publications

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“…There is much discussion in the literature regarding the interpretation and application of the ICER in cost-utility analyses 15. The quantitative thresholds set by Laupacis et al , in 1992 are criticized for being arbitrary and outdated, although they remain in frequent use 16–18. The National Institute of Health and Clinical Excellence of the British National Health Services uses ?20,000 per QALY gained as their ICER threshold for the acceptance of new technologies 1920…”

Section: How Can the Results Be Applied To Patient Care?mentioning

confidence: 99%

Users' guide to the orthopaedic literature: What is a cost-effectiveness analysis?

2008

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As the cost of healthcare continue to rise, orthopaedic surgeons are being pressured to practice cost-effective healthcare. Consequently, economic evaluation of treatment options are being reported more commonly in medical and surgical literature. As new orthopaedic procedures and treatments may improve patient outcome and function over traditional treatment options, the effect of the potentially higher costs of new treatments should be formally evaluated. Unfortunately, the resources available for healthcare spending are typically limited. Therefore, cost-effectiveness analyses have become an important and useful tool in informing which procedure or treatment to implement into practice.Cost-effectiveness analysis is a type of economic analysis that compares both the clinical outcomes and the costs of new treatment options to current treatment options or standards of care. For a clinician to be able to apply the results of a cost-effectiveness analysis to their practice, they must be able to critically review the available literature. Conducting an economic analysis is a challenging process, which has resulted in a number of published economic analyses that are of lower quality and may be fraught with bias. It is important that the reader of an economic analysis or cost-effectiveness analysis have the skills required to properly evaluate and critically appraise the methodology used before applying the recommendations to their practice.Using the principles of evidence-based medicine and the questions outlined in the Journal of the American Medical Association's Users' Guide to the Medical Literature, this article attempts to illustrate how to critically appraise a cost-effectiveness analysis in the orthopaedic surgery literature.

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Section: How Can the Results Be Applied To Patient Care?mentioning

confidence: 99%

Users' guide to the orthopaedic literature: What is a cost-effectiveness analysis?

2008

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“…The assumption of proportionality is not supported by the limited available evidence on the cost effectiveness of different types of treatment (Asim and Petros, 2005;O'Brien and Sculpher, 2000). It is also not supported by the variations in the ratios of unit costs to discounted health effects outcomes we have estimated in this paper.…”

Section: Indices For a Specimen Set Of Activities: Resultsmentioning

confidence: 99%

Improving the measurement of health system output growth

Castelli

Dawson

Gravelle³

et al. 2007

Health Economics

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National income accounting practice is to weight health service activities by their cost so that they can be aggregated into an output index. Quality changes are ignored. We propose an 'ideal' value weighted output index in which the value attached to each output reflects its contribution to health outcomes and other characteristics valued by patients. Calculation of the index for the health system as a whole is currently infeasible because of a lack of data, especially on health outcomes. We demonstrate alternative ways of combining health outcome data with existing information on post-treatment survival, life expectancy and waiting times to construct quality adjusted cost weighted and health outcome weighted indices for a small set of hospital activities for which there are health outcome data.

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“…There has been much discussion in the literature regarding the interpretation and application of the ICUR metric. In particular, the quantitative thresholds proposed by Laupacis et al (27) in 1992 have been criticized for being arbitrary and outdated, although they remain in frequent use (55)(56)(57). For example, the National Institute for Health and Clinical Excellence of the British National Health Service uses £20,000/QALY as their ICUR threshold for acceptance of new technologies (58,59).…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Superficial Inferior Epigastric Artery Flap and Deep Inferior Epigastric Perforator Flap in Postmastectomy Reconstruction: A Cost-Effectiveness Analysis

Thoma

Jansen

Sprague

et al. 2008

Canadian Journal of Plastic Surgery

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The best available evidence suggests the SIEA is a cost-effective procedure. However, given the high SIEA to DIEP conversion rates and small marginal differences in cost and effectiveness, the ICUR may be sensitive to minor changes in costs or QALYs. The 'truth' can only be obtained from a randomized, controlled trial comparing both techniques side by side, simultaneously capturing the costs of the competing interventions.

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Valuing a QALY: review of current controversies

Cited by 16 publications

References 12 publications

Users' guide to the orthopaedic literature: What is a cost-effectiveness analysis?

Users' guide to the orthopaedic literature: What is a cost-effectiveness analysis?

Improving the measurement of health system output growth

A Comparison of the Superficial Inferior Epigastric Artery Flap and Deep Inferior Epigastric Perforator Flap in Postmastectomy Reconstruction: A Cost-Effectiveness Analysis

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