Using cost-effectiveness measures to assess health screenings, drugs and surgeries could save the US about $412 billion, which is 14% of the $3 trillion the US spends on healthcare every year, if the government were allowed to take cost into account, according to a study published in Health Affairs.
Researchers from the University of Pennsylvania, University of Maryland, Merck and Pfizer, which funded the research, assessed 2,027 cases in which they compared the clinical effectiveness of a drug with its cost. They found that treatment recommendations were the same 81.1% of the time and that 28% of the time the cheaper option was also the more clinically effective one.
The researchers used a metric known as the quality-adjusted life-year (QALY), which takes into consideration the quality of life associated with an illness and the cost of care for each year of life a patient would gain on treatment.
Although the Affordable Care Act created the Patient-Centered Outcomes Research Institute to promote evidence-based treatment protocols, the legislation prevents the organization from considering the cost of treatment. QALYs are commonly used abroad, by government agencies like Great Britain’s National Institute for Health and Care Excellence, which develops healthcare guidelines.
The researchers wrote that the inability to consider comparative effectiveness and cost at the same time hampers experts’ ability to assess how well resources are being used. They also wrote that PCORI was barred from using these tools for a variety of reasons, including “public distaste for notions of rationing of healthcare … [and] fear that decisions about cost could inhibit innovation.”
They said, however, that the 81.1% agreement rate may mean that these concerns are unfounded. They also said that their findings show that basing treatment decisions on clinical effectiveness alone will lower healthcare costs in only a few instances.
Researchers examined studies funded by the pharmaceutical industry and non-industry sources. Pharmaceutical-funded studies showed agreement between clinical and cost-effectiveness 91.6% of the time, while studies that were not supported by the industry found clinical- and cost-effectiveness measures came to the same treatment conclusions 78.6% of the time.