Health care cost increases in the U.S. are unsustainable; there is universal agreement among U.S. health care stakeholders on this point. The uber-objective of “bending the cost curve” is a major sticking-point with the House-passed health reform bill.
Some see cost-effectiveness analysis (CEA) as one viable approach to managing health cost growth in the U.S. CEA balances health benefits of different clinical interventions for a specific condition and compares each intervention to their costs.
A report from the California HealthCare Foundation (CHCF), Value Proposition: The Role of Cost-Effectiveness in Coverage Decisions, clearly explains CEA and offers recommendations on how the method can be fairly implemented in the U.S.
CEA is used the world over to compared health therapies’ and procedures’ cost, impacts and patient outcomes. The United Kingdom’s NICE, the National Institute for Health and Clinical Excellence organization, for example, delivers guidelines based on the latest clinical evidence; their findings guide funding decisions for the National Health Service that directly impact patient care.
In the U.S., land of open-ended health choices and “free” clinical decision making, CEA is seen as an inhibitor of innovation for pharmaceuticals, medical devices, and surgical procedures.
CEA is used in many managed care organizations in the U.S. along with the VA and the DoD health systems, although is not widely deployed in Medicare. 90% of health plans have adopted CEA in making coverage decisions.
Health Populi’s Hot Points: Medicare is the single largest contributor to the long-term fiscal instability in the U.S. budget. Thus, adopting CEA in Medicare would make sense. To do so would require a major dose of transparency in CEA methodologies for each clinical area studied. There are assumptions underneath each CEA study which must be made explicit for this to work in Medicare, a publicly-funded program.
The CHCF report talks about NICE’s Citizen Council, comprised of 30 British health citizens broadly representing the demographics of England and Wales.
“Americans in their dual roles as tax-payers and users of health care have key roles to play in contributing to the discussion of priority setting,” the report concludes. By bringing American health citizens into the CEA process as true participants in health care and health coverage decision making, greater transparency and empowerment would be enhanced. CEA doesn’t have to mean rationing.
Cost-effectiveness is not a harbinger of rationing health care
By Jane Sarasohn-Kahn on 12 November 2009 in Uncategorized