Clinicians: Beware the Claim of Cost-Effectiveness

Brad Spellberg, MD


February 28, 2017

Who Pays the Bill?

In essence, the traditional societal approach taken by most cost-efficacy analyses is decreasingly reflective of how healthcare is paid for, in which the actual costs of care are borne by providers and hospitals, and increasingly firewalled away from societal costs. Society may deem the benefit of a new technology worth paying $50,000 per QALY saved, but if your office or hospital bears the cost, rather than society, services to other patients may have to be cut to absorb that cost.

As a result, you may have a very different perspective on the "value" of the new technology relative to its cost. You may have to balance the desire to add a "nice-to-have" technology that provides modest benefit to one patient against the resulting need to pay for that technology by reducing the quality of care delivered to many of your other patients who have equally pressing healthcare needs.

The bottom line is that it makes little difference whether a technology is considered cost-effective at the societal level if society is not paying the out-of-pocket costs for using the technology.[9] In this context, societal estimates of cost-efficacy may not be informative to providers making clinical care decisions.


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