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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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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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