Cost-Effectiveness of
Selected Measures and Treatments*

Intervention   Cost-Effectiveness Ratio (2010 Dollars)**   Source
Treating rheumatoid arthritis with drugs that slow disease progression   Saves money and improves health   Finckh. Annals of Internal Medicine 2009
Preventing esophagial cancer with daily aspirin in men age 55 with Barrett's esophagus (a possible reaction to chronic acid reflux)   Saves money and improves health   Hur. Journal of the National Cancer Institute 2004
Treating sciatica (a common form of low back pain and leg pain) with early surgery   Saves money and improves health   van den Hout. BMJ 2008
Training caregivers of stroke patients   Saves money and improves health   Patel. BMJ 2004
Using Coumadin (Warfirin) (an anticoagulant) for 70 year-olds with atrial fibrillation (irregular heart beat)   $3,000/QALY   O'Brien. JAMA 2005
Diabetes education and self management for people with type 2 diabetes   $4,000/QALY   Gillett. BMJ 2010
Daily dialysis for 60 year-old critically ill men with kidney injury   $6,000/QALY   Desai. Archives of Internal Medicine 2008
Using an implantable cardioverter defibrillator to prevent sudden cardiac death in high risk patients   $38,000/QALY   Sanders. New England Journal of Medicine 2005
HIV counseling, testing, and referral in high risk populations   $44,000/QALY   Paltiel. New England Journal of Medicine 2005
Treating spinal stenosis (narrowing of the spinal canal) and leg pain with spine surgery   $90,000/QALY   Tosteson. Annals of Internal Medicine 2008
Screening 60 year-old heavy smokers with annual CAT scans   $140,000/QALY   Mahadevia. JAMA 2003
Screening 65 year-old men for osteoporosis   $150,000/QALY   Schousboe. JAMA 2007
Adding tPA (a clot busting drug) to heparin (an anticoagulant) to treat blood clots in the lungs of patients with right ventrical dysfunction   Increases cost and makes health worse   Perlroth. Archives of Internal Medicine 2007
Annual HIV screening for people with a low to moderate risk   Increases cost and makes health worse   Paltiel. Annals of Internal Medicine 2006
         

 

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Intervention Change in Cost (2010 Dollars) Change in QALY Cost-Effectiveness Ratio (2010 Dollars)** Source
Disease-modifying antirheumatic drugs compared to the traditional pyramid strategy*** for newly diagnosed rheumatoid arthritis patients -6,000 0.30 Saves money and improves health Finckh. Annals of Internal Medicine 2009
Daily enteric-coated aspirin compared to no aspirin for men age 55 or older with Barrett's esophagus to prevent esophageal cancer -5,000 0.19 Saves money and improves health Hur. Journal of the National Cancer Institute 2004
Early surgery compared to prolonged conservative care to treat patients with sciatica from lumbar disc herniation -10 0.02 to 0.04 Saves money and improves health van den Hout. BMJ 2008
Training for the caregivers of stroke patients compared to no training -6,000 0.00 Saves money and improves health Patel. BMJ 2004
Coumadin (Warfirin) compared to aspirin for 70 year-olds with atrial fibrillation 3,000 0.81 3,000 O'Brien. JAMA 2005
Diabetes education and self management compared to standard care for patients newly diagnosed with type 2 diabetes 200 0.04 4,000 Gillett. BMJ 2010
Daily dialysis compared to dialysis every other day for 60 year-old critically ill men with kidney injury 13,000 2.14 6,000 Desai. Archives of Internal Medicine 2008
ICD (implantable cardioverter defibrillator) compared to current standard of care to prevent sudden cardiac death for patient who are at risk for sudden death due to left ventricular systolic dysfunction 113,000 3.00 38,000 Sanders. New England Journal of Medicine 2005
HIV counseling, testing, and referral compared to current standard of care in high risk populations (HIV annual incidence 1.2% and prevalence of undiagnosed HIV 0.3%) 1,000 0.03 44,000 Paltiel. New England Journal of Medicine 2005
Spine surgery compared to nonoperative treatment for adult patients with confirmed spinal stenosis and spinal nerve-based (radicular) leg pain 15,000 0.17 90,000 Tosteson. Annals of Internal Medicine 2008
Annual CT screening compare to no screening for 60 year-old heavy smokers who are eligible for lung reduction surgery 6,000 0.04 140,000 Mahadevia. JAMA 2003
Screening for osteoporosis with a bone densitometry and osteoporosis treatment compared to no densitometry or treatment for men age 65 and older with no prior fracture 4,000 0.03 150,000 Schousboe. JAMA 2007
Heparin sodium and alteplase compared to heparin sodium for hemodynamically stable patients with a submassive pulmonary embolism and right ventricular dysfunction 700 -0.05 Increases cost and makes health worse Perlroth. Archives of Internal Medicine 2007
Annual compared to tri-annual rapid HIV screening in moderate to low risk populations 1000 -0.003 Increases cost and makes health worse Paltiel. Annals of Internal Medicine 2006

 

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*   Selection criteria include non-industry funded studies which were published since 2003 in a journal whose impact factor is greater than or equal to 10. Among articles that met these criteria, we selected ratios that demostrated a range of cost-effectiveness.

** The cost-effectiveness ratio is the incremental costs divided by the incremental benefits, relative to a comparator. The cost-effectiveness estimates listed are point-estimate values from the original articles and have been rounded to the nearest thousand (a more detailed table appears at www.tufts-nemc.org/cearegistry). QALY denotes quality-adjusted life-year. For more information see www.cearegistry.org.

*** The pyramid strategy consists of initial nonsteroidal anti-inflammatory drugs, patient education, joint protection and therapeutic exercise, pain management, and low-dose glucocorticoids are administered as needed.