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Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold
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 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]
In the citing paper
“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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Metadata
- 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
- 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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