Much cheaper, almost as good: decrementally cost-effective medical innovation
- Overview
-
- Title:
- Much cheaper, almost as good: decrementally cost-effective medical innovation
- Authors:
- Nelson AL, Cohen JT, Greenberg D, Kent DM
- Journal:
- Ann Intern Med
- Publication date:
- 2009
- Volume:
- 151
- Issue:
- 9
- First page:
- 662
- Last page:
- 667
- ISSN:
- 1539-3704
- Link to pubmed:
- http://www.ncbi.nlm.nih.gov/pubmed/19884627
- Publication type:
- Journal
- Abstract
- Under conditions of constrained resources, cost-saving innovations may improve overall outcomes, even when they are slightly less effective than available options, by permitting more efficient reallocation of resources. The authors systematically reviewed all MEDLINE-cited cost-utility analyses written in English from 2002 to 2007 to identify and describe cost- and quality-decreasing medical innovations that might offer favorable "decrementally" cost-effective tradeoffs-defined as saving at least $100 000 per quality-adjusted life-year lost. Of 2128 cost-effectiveness ratios from 887 publications, only 9 comparisons (0.4% of total) described 8 innovations that were deemed to be decrementally cost-effective. Examples included percutaneous coronary intervention (instead of coronary artery bypass graft) for multivessel coronary disease, repetitive transcranial magnetic stimulation (instead of electroconvulsive therapy) for drug-resistant major depression, watchful waiting for inguinal hernias, and hemodialyzer sterilization and reuse. On a per-patient basis, these innovations yielded savings from $122 to almost $12 000 but losses of 0.001 to 0.021 quality-adjusted life-years (approximately 8 hours to 1 week). These findings demonstrate the rarity of decrementally cost-effective innovations in the medical literature.
- Preview
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Much cheaper, almost as good: decrementally cost-effective medical innovation Nelson AL, Cohen JT, Greenberg D, Kent DM. Ann Intern Med 2009; 151(9):662-667.