Director's LetterHealth payers in the U.S. have often balked at using formal cost-effectiveness analysis in coverage and reimbursement decisions for medical technologies. The Medicare program, for example, does not consider cost or cost-effectiveness in its coverage decisions for new treatments, despite fiscal challenges and multiple initiatives to achieve better value. Less well known, however, is that cost-effectiveness analysis has played a longstanding role in informing the addition of preventive
services to Medicare. It has provided Medicare officials information to help ensure that health gains are achieved at reasonable cost. Our new paper on the topic and other research highlights are described below. Medicare is scrutinizing evidence more tightly for new medical technologies. Our analysis suggests that Medicare national coverage decisions are becoming more restrictive. Chambers, JD, Chenoweth M, Cangelosi MJ, Pyo J, Cohen JT, Neumann PJ. Medicare is Scrutinizing Evidence More Tightly for National Coverage
Determinations. Health Affairs 2015;34(2):253–260. Multiple conditions in type 2 diabetes patients: prevalence and consequences. We document the prevalence of comorbidity clusters (e.g., hypertension, hyperlipidemia, heart failure) in type 2 diabetes patients, and their consequences, including, excess emergency department visits, and hospital re-admissions. Lin P-J, Kent DM, Winn A, Cohen JT, Neumann PJ. Multiple Chronic Conditions in Type 2 Diabetes Mellitus: Prevalence and
Consequences. AJMC 2015;21(1):e23-e34. 10 case studies for FDAMA Section 114. Ten case studies explore potential promotional claims under the FDAMA Section 114 statute (which governs what drug companies can say to formulary committees about health economic messages). Does a claim about “adherence”? Hospitalization? Neumann PJ, Saret C. When Does FDAMA Section 114 Apply? Ten Case Studies. Value in Health 2015. [Epub ahead of print]. Our webinar on the topic will be June 2. The Tufts Medical Center Cost-Effectiveness Analysis Registry is now updated through 2013. Through 2013, the Registry contains information on: 4,339 cost-utility analyses articles published from 1976 through 2013; 11,880 cost-effectiveness ratios; 16,946 utility weights. Medicare has used cost-effectiveness analysis when covering preventive services, but not treatment. A full list of all preventive services Medicare has covered over the years is here. Chambers JD, Cangelosi MJ, Neumann PJ. Medicare's use of cost-effectiveness analysis for prevention (but not for
treatment). Health Policy 2015. 119(2):156-63. Despite high costs, studies show that interventions for blood cancers may be cost-effective. The 29 cost-utility studies (22 funded by the pharmaceutical industry) published through 2012 tend to show reasonable value for money. However, prices have jumped since 2012, which could change the picture going forward. Saret CJ, Winn A, Shah G, Parsons SK, Lin PJ, Cohen JT, Neumann PJ. Value of Innovation in Hematologic Malignancies. Blood 2015.
125(12):1866-9. The changing face of the cost utility literature, 1990-2012. Through 2012, 3,753 cost-per QALY studies have been published in English language, peer-review journals. The number averaged 34 per year from 1990 to 1999 and 431 per year from 2010 to 2012. Recent growth has been strong in non-Western countries. Neumann PJ, Thorat T, Shi J, Saret CJ, Cohen JT. The Changing Face of the Cost Utility Literature, 1990-2012. Value in Health 2015. 18(2):271-277. The lag from FDA approval to published cost-effectiveness evidence. The majority of drugs (54%) approved by the FDA from 2000 to 2010 do not have an associated published cost-utility analysis (CUA), and only 23% had a corresponding CUA 3 years following approval. Chambers JD, Thorat T, Pyo J, Neumann PJ. The Lag from FDA Approval to Published Cost-Utility Evidence. Expert Rev 2015. 12:1-4. Peter Neumann, Sc.D.
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