Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold

Grosse, Scott D

doi:10.1586/14737167.8.2.165

Cited by 637Health Systems, Economic Evaluations, Quality of LifePharmaceutical Economics and PolicyEconomic and Environmental Valuation

Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold

Grosse, Scott D·2008·Expert Review of Pharmacoeconomics & Outcomes Research

DOI 10.1586/14737167.8.2.165

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Abstract

Cost-effectiveness analyses, particularly in the USA, commonly use a figure of $50,000 per life-year or quality-adjusted life-year gained as a threshold for assessing the cost-effectiveness of an intervention. The history of this practice is ill defined, although it has been linked to the end-stage renal disease kidney dialysis cost-effectiveness literature from the 1980s. The use of $50,000 as a benchmark for assessing the cost-effectiveness of an intervention first emerged in 1992 and became widely used after 1996. The appeal of the $50,000 figure appears to lie in the convenience of a round number rather than in the value of renal dialysis. Rather than arbitrary thresholds, estimates of willingness to pay and the opportunity cost of healthcare resources are needed.

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In the USA, a cost-effectiveness threshold of US$50,000 per QALY gained was used.
“in the USA US$50,000 per Quality Adjusted Life Years (QALY) gained were used [29].”
From Cost and cost-effectiveness of mHealth interventions for the prevention and control of type 2 diabetes mellitus: A systematic review (2020) · cites this paper as [29]
It is often stated that interventions that cost less than $50,000 per QALY are a good value.
“Although there is no hard and fast rule, it is often stated that interventions that cost less than $50,000 per QALY are a good value [6].”
From Cost Effectiveness of Internet Interventions: Review and Recommendations (2009) · cites this paper as [6]

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Priorities Among Effective Clinical Preventive Services
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The Costs, Clinical Benefits, and Cost-Effectiveness of Screening for Cervical Cancer in HIV-Infected Women
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The Cost-effectiveness of Air Bags by Seating Position
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The efficacy and cost-effectiveness of adjuvant therapy of early breast cancer in premenopausal women.
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Economic Evaluation of HIV Prevention Programs
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Is it really possible to build a bridge between cost-benefit analysis and cost-effectiveness analysis?
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Limitations of Acceptability Curves for Presenting Uncertainty in Cost-Effectiveness Analysis
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Improving Value Measurement in Cost-Effectiveness Analysis
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Cost-Effectiveness Studies of Renal Transplantation
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Use of Quality Adjusted Life Years and Life Years Gained as Benchmarks in Economic Evaluations: A Critical Appraisal
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Cost-Effectiveness And Evidence Evaluation As Criteria For Coverage Policy
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The biggest bang for the buck or bigger bucks for the bang: the fallacy of the cost-effectiveness threshold
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Potential health benefits of nutrition label changes.
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Cost-Effectiveness versus Cost–Utility Analysis of Interventions for Cancer: Does Adjusting for Health-Related Quality of Life Really Matter?
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Using Cost-Effectiveness Analysis to Improve Health Care
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Cost-effectiveness analysis in heart disease, part III: Ischemia, congestive heart failure, and arrhythmias
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Willingness to Pay per Quality-Adjusted Life Year in a Study of Knee Osteoarthritis
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Cost-effectiveness analysis of potential improvements to emergency medical services for victims of out-of-hospital cardiac arrest
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Should Canada and the United States Universally Vaccinate Infants against Hepatitis B?
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Impact and cost-effectiveness of smoking interventions
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Pharmaco‐economics of blood transfusion safety: review of the available evidence
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A cost-effectiveness analysis of the treatment of chronic renal failure
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Cost-Effectiveness League Tables
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Task Force 6: Coronary artery disease
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Can we estimate the ‘social’ value of a QALY?
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A Cost-Effectiveness Analysis of Continuous Ambulatory Peritoneal Dialysis and Hospital Hemodialysis
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Cost-effectiveness of angiography performed during surgery for ruptured intracranial aneurysms.
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The impact of information on non-health attributes on willingness to pay for multiple health care programmes
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Should Hemodialysis Patients With Atrial Fibrillation Undergo Systemic Anticoagulation? A Cost-Utility Analysis
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Threshold Analysis and Programs for Prevention of HIV Infection
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Assessing Preferences for Prevention versus Treatment Using Willingness to Pay
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Overcorrection of hyponatremia: Where do we go wrong?
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The Cost-Effectiveness of Magnetic Resonance Imaging for Patients with Equivocal Neurological Symptoms
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Economic analyses in health care: An introduction to the methodogy with an emphasis on radiation therapy
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Screening Surgeons for HIV Infection: A Cost-effectiveness Analysis
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Estimating the cost effectiveness of total androgen blockade with flutamide in M1 prostate cancer
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National Institute for Clinical Excellence (NICE): Is Economic Appraisal Working?
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Economic evaluation and end-stage renal disease: From basics to bedside
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Incorporating Recipient Choice in Kidney Transplantation
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Cost-Effectiveness of Assessment and Management of Risk Factors
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Valuing avoided morbidity using meta‐regression analysis: what can health status measures and QALYs tell us about WTP?
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Cost-Effectiveness in a Flat World — Can ICDs Help the United States Get Rhythm?
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High-Priced Technology Can Be Good Value for Money
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Reporting Cost-Effectiveness Studies and Results
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Determinants of the Cost-Effectiveness of Statins
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A utility‐theoretic model for QALYs and willingness to pay
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Cost Effectiveness of Newer Antiviral Agents for Herpes Zoster: Is the Evidence Spotty?
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Quality-adjusted life years was a poor predictor of women's willingness to pay in acute and chronic conditions: results of a survey
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The Value Of Coronary Heart Disease Care For The Elderly: 1987–2002
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Implicit versus explicit ranking: On inferring ordinal preferences for health care programmes based on differences in willingness-to-pay
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Clinical effectiveness and cost effectiveness of influenza vaccination among healthy working adults
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Analytic Tools for Public Health Decision Making
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Optimal management strategies for HIV-infected patients who present with cough or dyspnea
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Health state values from multiattribute utility instruments need correction
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Publishing web‐based guidelines using interactive decision models
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Cutting Into Cholesterol
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Thresholds in Cost-Effectiveness Analysis—More of the Story
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Decision Rules for Incremental Cost-effectiveness Analysis
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Economic analyses and clinical practice guidelines why not a match made in heaven?
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Prioritizing Health Care: Is “Health” Always an Appropriate Maximand?
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Terminology I would like to see disappear
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Decision Rules in Economic Evaluation
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PMC14 PREVAILING JUDGMENTS ABOUT SOCIETY'S WILLINGNESS TO PAY FORA QALY: DO THEY VARY BY COUNTRY? HAVE THEY CHANGED OVERTIME?
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Cost-Effectiveness Analysis of Organ Transplantation
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Using Economic Evaluations in Decision Making
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Updating cost-effectiveness—the curious resilience of the $50,000-per-QALY threshold
Neumann, P. J., Cohen, J. T., & Weinstein, M. C. (2014) · New England Journal of Medicine · doi:10.1056/nejmp1405158 · Cited by 2,249 · see citing works
Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold
Claxton, K., Martin, S., Soares, M. O., Rice, N., Spackman, E., Hinde, S., Devlin, N. J., Smith, P., & Sculpher, M. J. (2015) · Health Technology Assessment · doi:10.3310/hta19140 · Cited by 859 · see citing works
Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review
Li, R., Zhang, P., Barker, L. E., Chowdhury, F. M., & Zhang, X. (2010) · Diabetes Care · doi:10.2337/dc10-0843 · Cited by 491 · see citing works
The Societal and Economic Value of Rotator Cuff Repair
Mather, R. C. “., Koenig, L., Acevedo, D., Dall, T. M., Gallo, P. D., Romeo, A. A., Tongue, J. R., & Williams, G. R. (2013) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.l.01495 · Cited by 409 · see citing works
On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review
Cameron, D. A., Ubels, J., & Norström, F. (2018) · Global Health Action · doi:10.1080/16549716.2018.1447828 · Cited by 370 · see citing works
Integrative Health Coaching for Patients With Type 2 Diabetes
Wolever, R. Q., Dreusicke, M., Fikkan, J., Hawkins, T. V., Yeung, S., Wakefield, J., Duda, L., Flowers, P., Cook, C., & Skinner, E. (2010) · The Diabetes Educator · doi:10.1177/0145721710371523 · Cited by 317 · see citing works
Economic evaluation alongside randomised controlled trials: design, conduct, analysis, and reporting
Petrou, S., & Gray, A. (2011) · British medical journal · doi:10.1136/bmj.d1548 · Cited by 313 · see citing works
The cost-effectiveness of genetic testing strategies for Lynch syndrome among newly diagnosed patients with colorectal cancer
Mvundura, M., Grosse, S. D., Hampel, H., & Palomaki, G. E. (2010) · Genetics in Medicine · doi:10.1097/gim.0b013e3181cd666c · Cited by 292 · see citing works
Cost Effectiveness of Internet Interventions: Review and Recommendations
Tate, D. F., Finkelstein, E. A., Khavjou, O., & Gustafson, A. (2009) · Annals of Behavioral Medicine · doi:10.1007/s12160-009-9131-6 · Cited by 261 · see citing works
Economic evaluation of dialysis therapies
Klarenbach, S. W., Tonelli, M. A., Chui, B. K., & Manns, B. (2014) · Nature Reviews Nephrology · doi:10.1038/nrneph.2014.145 · Cited by 261 · see citing works
Cost-effectiveness of Primary Screening for CKD: A Systematic Review
Komenda, P. V. J., Ferguson, T. W., Macdonald, K., Rigatto, C., Koolage, C., Sood, M. M., & Tangri, N. (2014) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2013.12.012 · Cited by 249 · see citing works
A Health Opportunity Cost Threshold for Cost-Effectiveness Analysis in the United States
Vanness, D. J., Lomas, J. R. S., & Ahn, H. H. (2020) · Annals of Internal Medicine · doi:10.7326/m20-1392 · Cited by 243 · see citing works
Global implementation of genomic medicine: We are not alone
Manolio, T. A., Abramowicz, M. J., Al‐Mulla, F., Anderson, W. P., Balling, R., Berger, A. C., Bleyl, S. B., Chakravarti, A., Chantratita, W., Chisholm, R. L., et al. (2015) · Science Translational Medicine · doi:10.1126/scitranslmed.aab0194 · Cited by 239 · see citing works
Cost-effectiveness of Aflibercept, Bevacizumab, and Ranibizumab for Diabetic Macular Edema Treatment
Ross, E. L., Hutton, D. W., Stein, J. D., Bressler, N. M., Jampol, L. M., & Glassman, A. R. (2016) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2016.1669 · Cited by 210 · see citing works
The cost-effectiveness of male HPV vaccination in the United States
Chesson, H. W., Ekwueme, D. U., Saraiya, M., Dunne, E. F., & Markowitz, L. E. (2011) · Vaccine · doi:10.1016/j.vaccine.2011.07.096 · Cited by 204 · see citing works
Reducing the burden of suffering from eating disorders: unmet treatment needs, cost of illness, and the quest for cost-effectiveness
Striegel Weissman, R., & Rosselli, F. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.09.006 · Cited by 184 · see citing works
Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations
Herman, P. M., Poindexter, B. L., Witt, C. M., & Eisenberg, D. M. (2012) · BMJ Open · doi:10.1136/bmjopen-2012-001046 · Cited by 185 · see citing works
The cost-effectiveness of telestroke in the treatment of acute ischemic stroke
Nelson, R. E., Saltzman, G. M., Skalabrin, E. J., Demaerschalk, B. M., & Majersik, J. J. (2011) · Neurology · doi:10.1212/wnl.0b013e318234332d · Cited by 178 · see citing works
Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review
Jack, H. E., Arabadjis, S. D., Sun, L., Sullivan, E. E., & Phillips, R. S. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-016-3922-9 · Cited by 156 · see citing works
Understanding the global measurement of willingness to pay in health
McDougall, J. A., Furnback, W. E., Wang, B. C. M., & Mahlich, J. (2020) · Journal of Market Access & Health Policy · doi:10.1080/20016689.2020.1717030 · Cited by 164 · see citing works
Cost-Effectiveness of Bariatric Surgery for Severely Obese Adults With Diabetes
Hoerger, T. J., Zhang, P., Segel, J. E., Kahn, H. S., Barker, L. E., & Couper, S. (2010) · Diabetes Care · doi:10.2337/dc10-0554 · Cited by 163 · see citing works
Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States
Delgado, M. K., Staudenmayer, K., Wang, N. E., Spain, D. A., Weir, S., Owens, D. K., & Goldhaber‐Fiebert, J. D. (2013) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2013.02.025 · Cited by 156 · see citing works
Cost-effectiveness analysis of intra-articular injections of a high molecular weight bioengineered hyaluronic acid for the treatment of osteoarthritis knee pain
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Systematic overview of cost–effectiveness thresholds in ten countries across four continents
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Economic Evaluation of a Neural Tube Defect Recurrence–Prevention Program
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Healthcare Rationing by Proxy
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Authors: Grosse, S. D.
Affiliations: Centers for Disease Control and Prevention (US)
Corresponding author: Grosse, Scott D
ORCID: Grosse, Scott D
Venue: Expert Review of Pharmacoeconomics & Outcomes Research
Publisher: Informa UK Limited
Published: 2008-04
Volume: 8
Issue: 2
Pages: 165-178
ISSN: 1473-7167 (ISSN-L)
1744-8379
DOI: 10.1586/14737167.8.2.165
OpenAlex: W2117419474
Cited by: 637
References: 179
Citations by year: 2026: 18 · 2025: 21 · 2024: 20 · 2023: 23 · 2022: 40 · 2021: 40 · 2020: 48 · 2019: 45 · 2018: 40 · 2017: 55 · 2016: 45 · 2015: 58 · 2014: 52 · 2013: 49 · 2012: 32
FWCI: 39.35
Type: journal article
Language: en
Open access: closed
Locations: Expert Review of Pharmacoeconomics & Outcomes Research (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
Keywords: cost-effectiveness threshold, quality-adjusted life years, willingness to pay, end-stage renal disease, dialysis, healthcare resource allocation

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Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold

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