Incremental cost-effectiveness ratio - Wikipedia

A common application of the ICER is in cost-utility analysis, in which case the ICER is synonymous with the cost per quality-adjusted life year (QALY) gained. Incrementalcost-effectivenessratio FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Theincrementalcost-effectivenessratio(ICER)isastatisticusedincost-effectivenessanalysistosummarisethecost-effectivenessofahealthcareintervention.Itisdefinedbythedifferenceincostbetweentwopossibleinterventions,dividedbythedifferenceintheireffect.Itrepresentstheaverageincrementalcostassociatedwith1additionalunitofthemeasureofeffect.TheICERcanbeestimatedas: I C E R = ( C 1 − C 0 ) ( E 1 − E 0 ) {\displaystyleICER={\frac{(C_{1}-C_{0})}{(E_{1}-E_{0})}}} , where C 1 {\textstyleC_{1}} and E 1 {\displaystyleE_{1}} arethecostandeffectintheinterventiongroupandwhere C 0 {\textstyleC_{0}} and E 0 {\textstyleE_{0}} arethecostandeffectinthecontrolcaregroup.[1]Costsareusuallydescribedinmonetaryunits,whileeffectscanbemeasuredintermsofhealthstatusoranotheroutcomeofinterest.AcommonapplicationoftheICERisincost-utilityanalysis,inwhichcasetheICERissynonymouswiththecostperquality-adjustedlifeyear(QALY)gained. Useasadecisionrule[edit] TheICERcanbeusedasadecisionruleinresourceallocation.Ifadecision-makerisabletoestablishawillingness-to-payvaluefortheoutcomeofinterest,itispossibletoadoptthisvalueasathreshold.IfforagiveninterventiontheICERisabovethisthresholditwillbedeemedtooexpensiveandthusshouldnotbefunded,whereasiftheICERliesbelowthethresholdtheinterventioncanbejudgedcost-effective.ThisapproachhastosomeextentbeenadoptedinrelationtoQALYs;forexample,theNationalInstituteforHealthandCareExcellence(NICE)adoptsanominalcost-per-QALYthresholdof£20,000to£30,000.[2]Assuch,theICERfacilitatescomparisonofinterventionsacrossvariousdiseasestatesandtreatments.In2009,NICEsetthenominalcost-per-QALYthresholdat£50,000forend-of-lifecarebecausedyingpatientstypicallybenefitfromanytreatmentforamatterofmonths,makingthetreatment'sQALYssmall.[3]In2016,NICEsetthecost-per-QALYthresholdat£100,000fortreatmentsforrareconditionsbecause,otherwise,drugsforasmallnumberofpatientswouldnotbeprofitable.[3]TheuseofICERsthereforeprovidesanopportunitytohelpcontainhealthcarecostswhileminimizingadversehealthconsequences.[4]TreatmentsforpatientswhoareneardeathofferfewQALYssimplybecausethetypicalpatienthasonlymonthslefttobenefitfromtreatment.Theyalsoprovidetopolicymakersinformationonwhereresourcesshouldbeallocatedwhentheyarelimited.[5]Ashealthcarecostshavecontinuedtorise,manynewclinicaltrialsareattemptingtointegrateICERintoresultstoprovidemoreevidenceofpotentialbenefit.[6] Controversies[edit] Manypeoplefeelthatbasinghealthcareinterventionsoncost-effectivenessisatypeofhealthcarerationingandhaveexpressedconcernthatusingICERwilllimittheamountortypesoftreatmentsandinterventionsavailabletopatients.[5]Currently,theNationalInstituteforHealthandCareExcellence(NICE)ofEngland'sNationalHealthService(NHS)usescost-effectivenessstudiestodetermineifnewtreatmentsortherapiesatthepricesproposedbymanufacturersprovidebettervaluerelativetothetreatmentthatiscurrentlyinuse.Withthenumberofcost-effectivenessstudiesrising,itispossibleforacost-effectivenessratiothresholdtobeestablishedinothercountriesfortheacceptanceofreimbursementorformularylistingatagivenprice. ResearchbytheUniversityofYorkidentifiedthatthecostperqualityadjustedlifeyearforchangesinexistingNHSexpenditurein2008was£12,936leadingtoconcernsnewtreatmentsapprovedbyNICEat£30,000perqualityadjustedlifeyeararelesscost-effectivethanspendonexistingtreatments.ThiswouldmeanthatdivertingNHSspendtonewtreatmentswouldforgomorethan2qualityadjustedlifeyearsforeveryyeargainedfromthenewtreatment.[7] TheconcernthatICERmayleadtorationinghasaffectedpolicymakersintheUnitedStates.ThePatientProtectionandAffordableCareActof2010providedforthecreationoftheindependentPatient-CenteredOutcomesResearchInstitute(PCORI).TheSenateFinanceCommitteeinwritingPPACAforbadePCORIfromusing"dollars-per-qualityadjustedlifeyear(orsimilarmeasurethatdiscountsthevalueofalifebecauseofanindividual'sdisability)asathresholdtoestablishwhattypeofhealthcareiscosteffectiveorrecommended".[8] References[edit] ^Whatistheincrementalcost-effectivenessratio(ICER)?GaBIOnline.[1].Accessed20March2012. ^Appleby,John;Devlin,Nancy;Parkin,David(2007)."NICE'scosteffectivenessthreshold".BMJ.335(7616):358–9.doi:10.1136/bmj.39308.560069.BE.PMC 1952475.PMID 17717337. ^ab"ThreeNICEthresholdsforcost-effectiveness:doesthatmakesense?-Pharmaphorum".Pharmaphorum.2016-11-25.Retrieved2017-01-10. ^OrszagPR,EllisP(2007)."Addressingrisinghealthcarecosts—AviewfromtheCongressionalBudgetOffice".NEnglJMed.357(18):1885–1887.doi:10.1056/NEJMp078190.PMID 17978287. ^abCost-effectiveMedicalTreatment:PuttinganUpdatedDollarValueonHumanLife.Knowledge@Wharton,30April2008.[2].Accessed20March2012. ^RamseyS,WillkeR,BriggsA,BrownR,BuxtonM,ChawlaA,CookJ,GlickH,LiljasB,PetittiD,ReedS(2005)."Goodresearchpracticesforcost-effectivenessanalysisalongsideclinicaltrials:TheISPORRCT-CEAtaskforcereport".ValueinHealth.8(5):521–533.doi:10.1111/j.1524-4733.2005.00045.x.PMID 16176491. ^ClaxtonK,MartinS,SoaresM,RiceN,SpackmanE,HindeS,DevlinN,SmithPC,SculpherM(2015)."MethodsfortheestimationoftheNICEcosteffectivenessthreshold".HealthTechnologyAssessment.19(14):1–503,v–vi.doi:10.3310/hta19140.PMC 4781395.PMID 25692211. ^WilkersonJ.PCORIheadvowsnottodocost-effectivenessstudies,butnotesgrayareasArchived2012-07-09atarchive.today.InsideHealthPolicy.com,28September2011.Accessed20March2012. vteHealthcarequalityConceptsofquality Evidence-basedmedicine Medicalconsensus Medicalguideline Healthcareevaluations Clinicalaudit Clinicalpeerreview Independentmedicalreview Healthcareratings Healthimpactassessment Healthservicesresearch Routinehealthoutcomesmeasurement Accreditation Hospitalaccreditation Internationalhealthcareaccreditation Listofinternationalhealthcareaccreditationorganizations Costsandbenefits Incrementalcost-effectivenessratio Cost-effectivenessanalysis Cost-minimizationanalysis Costperprocedure Tools ClinicalQualityManagementSystem Disability-adjustedlifeyear Incrementalcost-effectivenessratio Quality-adjustedlifeyear Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Incremental_cost-effectiveness_ratio&oldid=1092648082" Categories:CostsHealtheconomicsHealthcarequalityHiddencategories:Webarchivetemplatearchiveislinks Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English Views ReadEditViewhistory More Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Languages العربيةEspañolPolskiSlovenščinaSvenska Editlinks