In a new paper in the New England Journal of Medicine, my colleague Milton Weinstein and I analyze the U.S.’s new restrictions against the use of cost-effectiveness analysis (Neumann PJ and Weinstein MC, Legislating against Use of Cost-Effectiveness Information. N Engl J Med, 2010;363:1495-97).
Specifically, the recently enacted Patient Protection and Affordable Care Act states:
“…the Patient Centered Outcomes Research Institute … shall not develop or employ a dollars per quality adjusted life year (or similar measure that discounts the value of a life because of an individual’s disability) as a threshold to establish what type of health care is cost-effective or recommended. The Secretary shall not utilize such an adjusted life year (or such a similar measure) as a threshold to determine coverage, reimbursement, or incentive programs under title XVIII...”
Importantly, the ACA forbids the use of cost per QALYs "as a threshold.” The precise intent and consequence of this language is unclear. One might interpret it to mean that the PCORI, or its contractors or grantees, can still calculate a cost per QALY ratio, as long as it not compared to a threshold (e.g., $50,000/QALY) or used to make a recommendation based on such a threshold. Comparisons of cost per QALY ratios across interventions could still be useful to decision makers even without the invocation of an explicit threshold. However, the provision suggests a broader ban on the use of cost-utility analysis and, unfortunately, could have a chilling effect on the field.
By: Peter J. Neumann