Comparative effectiveness and cost-effectiveness analyses frequently agree on value.
The Patient-Centered Outcomes Research Institute, known as PCORI, was established by Congress as part of the Affordable Care Act (ACA) to promote evidence-based treatment. Provisions of the ACA prohibit the use of a cost-effectiveness analysis threshold and quality-adjusted life-years (QALYs) in PCORI comparative effectiveness studies, which has been understood as a prohibition on support for PCORI's conducting conventional cost-effectiveness analyses. This constraint complicates evidence-based choices where incremental improvements in outcomes are achieved at increased costs of care. How frequently this limitation inhibits efficient cost containment, also a goal of the ACA, depends on how often more effective treatment is not cost-effective relative to less effective treatment. We examined the largest database of studies of comparisons of effectiveness and cost-effectiveness to see how often there is disagreement between the more effective treatment and the cost-effective treatment, for various thresholds that may define good value. We found that under the benchmark assumption, disagreement between the two types of analyses occurs in 19 percent of cases. Disagreement is more likely to occur if a treatment intervention is musculoskeletal and less likely to occur if it is surgical or involves secondary prevention, or if the study was funded by a pharmaceutical company.
Henry A. Glick is a professor of medicine in the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, in Philadelphia.
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Sean McElligott is associate director of customer data and analytics at Merck in North Wales, Pennsylvania.
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Mark V. Pauly (pauly@wharton.upenn.edu) is the Bendheim Professor in the Health Care Management Department at the Wharton School, University of Pennsylvania.
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Richard J. Willke is vice president of Cardiovascular/Metabolic, Pain, Gender Health, and Respiratory Outcomes and Evidence, Global Health and Value at Pfizer Inc. in New York City.
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Henry Bergquist is a PhD candidate in the Health Care Management Department at the Wharton School, University of Pennsylvania.
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Jalpa Doshi is an associate professor of medicine in the Health Services Research Unit of the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania.
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Lee A. Fleisher is chair and Robert Dunning Dripps Professor of Anesthesiology and Critical Care in the Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania.
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Bruce Kinosian is an associate professor of medicine in the Perelman School of Medicine, University of Pennsylvania.
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Eleanor Perfetto is a professor at the School of Pharmacy-Pharmaceutical Health Services Research, University of Maryland, Baltimore.
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Daniel E. Polsky is executive director and the Robert D. Eilers Professor in Health Care Management and Economics at the Leonard Davis Institute of Health Economics, University of Pennsylvania.
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J. Sanford Schwartz is the Leon Hess Professor in Internal Medicine in the Division of General Internal Medicine, Perelman School of Medicine, at the University of Pennsylvania.
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D019985:Benchmarking / Q000191:economics; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis / Q000191:economics*; D017048:Health Care Costs; D061889:Healthcare Financing; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000191:economics; D063868:Patient Outcome Assessment; D058991:Patient Protection and Affordable Care Act / Q000191:economics* / Q000458:organization & administration*; D011787:Quality of Health Care / Q000191:economics; D019057:Quality-Adjusted Life Years; D014481:United States; D000070376:Value-Based Health Insurance / Q000191:economics*
Cost of Health Care; Financing Health Care; Health Economics; Health Reform; Quality Of Care