Unbiased Analysis of Today's Healthcare Issues
James Chambers has put together a series of papers looking at health gains (and cost effectiveness) using the Tufts Cost Effectiveness Analysis Registry. In these studies , he finds that treatments for rare diseases, specialty drugs, and those that receive expedited review are more likely to provide the largest health benefit (≥0.9 QALYs gained versus…
One concern when using quality adjusted life years (QALY) to measure health gains for cost effectiveness research is that QALYs “undervalue” health gains from life extension for people with serious illness or chronic disability. To see this clearly, take a look at the QALY formula (first formula below) and how it can be decomposed into…
That is the questions Peter Neumann and David Kim (2023) answer in their JAMA research letter published today. They use 1990-2021 data from the Tufts Medical Center CEA Registry. The results are summarized in the graphs below. First, we see the use of a explicit cost effectiveness threshold increasing over time, from only 45% of…
Both the Inflation Reduction Act and Affordable Care Act contained language that made cost-effectiveness analysis difficult to implement, while allowing for the analysis of comparative effectiveness with respect to the relative health benefits across treatments. This leads to the natural question, how often are would reimbursement decisions based on comparative effectiveness alone be the same…
In recent years, policymakers and payers have been focused increasingly not only on how new health technologies improve overall health, but also whether they can reduce health disparities. Oftentimes, however, discussions around health disparities are conducted on a qualitative basis with litlted quantitative analysis of tradeoffs between equity and effectiveness. Distributional cost effectiveness analysis (DCEA)…
That is according to a paper by Weaver et al. (2022). The authors use expenditure data from the Disease Expenditure Project and DALYs from the Global Burden of Disease Study 2017. Evaluating the data from 1996-2016, the authors find that: Across all causes of health care spending and disease burden, median spending was US$114,339 per…
How do you measure changes in quality of life for patients with cancer? Today we will review 3 different approaches: health state based, health state with age decrements, and health state with time-to-death (TTD) decrements. Health state based. One common approach is just to use the quality of life of a given health state. For…
If you were a drug manufacturer, you naturally would want to focus your research on more common, highly prevalent diseases. If there are more patients with the disease, that means more drugs that can be sold. In recent years, however, the number of so-called “orphan drugs” has increased. In the 1970s, only 10 orphan drugs…
In the United Kingdom, the National Institute for Health and Care Excellence (NICE) made an update to their health technology evaluations manual in January 2022. Of particular interest, section 6.2 of the manual states that the review committee “will consider the associated absolute and proportional QALY shortfall.” The committee defined QALY shortfall two ways: Absolute…
Standard quality approach compares the difference in QALYs which is a function of survival and quality of life during each survival period. Consider the comparison of treatments A and B, where treatment A is the novel treatment and treatment B is the standard of care. Under the QALY based approach this is calculated as Where…