Oregon's Medicaid ranking and cost-effectiveness: is there any relationship?
The authors examine whether Oregon's 1990, 1991, 1992, and 1993 prioritized lists were ranked in a manner consistent with cost-effectiveness. Two sets of cost-effectiveness data are used: data from economic analyses and Oregon's own cost-effectiveness data. Comparing the ranks of Oregon's lists with the ranks of cost-effectiveness estimates from the literature reveals Spearman correlations of -0.08 for the 1990 list, +0.39 for the 1991 list, +0.25 for the 1992 list, and +0.24 for the 1993 list. Comparing Oregon's lists with Oregon's own cost-effectiveness data reveals rank correlations of +0.99 for the 1990 list, +0.06 for the 1991 list, -0.05 for the 1992 list, and -0.03 for the 1993 list. Thus, there appear to be essentially no relationship between the 1990 list and cost-effectiveness estimates from the economic literature and modest positive relationships between the 1991-93 lists and the literature. In addition, there is virtually no relationship between the 1991-93 lists and Oregon's own cost-effectiveness data. Further, the correlations are very different from +1.0, suggesting that other factors are at play. For example, the 1993 list that is currently being implemented was ranked primarily by improvement in five-year survival and human judgment, not cost-effectiveness.
Tengs
T O
TO
Center for Health Policy Research and Education, Duke University, Durham, NC 27708, USA. tengs001@mc.duke.edu
Meyer
G
G
Siegel
J E
JE
Pliskin
J S
JS
Graham
J D
JD
Weinstein
M C
MC
D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003627:Data Interpretation, Statistical; D015276:Health Care Rationing / Q000191:economics; D006292:Health Priorities / Q000191:economics*; D006801:Humans; D008484:Medicaid / Q000191:economics*; D009922:Oregon; D013221:State Health Plans / Q000191:economics*; D016019:Survival Analysis; D014481:United States