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

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.