Much Cheaper, Almost as Good: Decrementally Cost-Effective Medical Innovation

作者：Nelson Aaron L; Cohen Joshua T; Greenberg Dan; Kent David M^*

来源：Annals of Internal Medicine, 2009, 151(9): 662-W219.

DOI：10.7326/0003-4819-151-9-200911030-00011

Under conditions of constrained resources, cost-saving innovations may improve overall outcomes, even when they are slightly less effective than available options, by permitting more efficient reallocation of resources. The authors systematically reviewed all MEDLINE-cited cost-utility analyses written in English from 2002 to 2007 to identify and describe cost- and quality-decreasing medical innovations that might offer favorable "decrementally" cost- effective tradeoffs-defined as saving at least $100 000 per quality-adjusted life-year lost. Of 2128 cost- effectiveness ratios from 887 publications, only 9 comparisons (0.4% of total) described 8 innovations that were deemed to be decrementally cost- effective. Examples included percutaneous coronary intervention (instead of coronary artery bypass graft) for multivessel coronary disease, repetitive transcranial magnetic stimulation (instead of electroconvulsive therapy) for drug-resistant major depression, watchful waiting for inguinal hernias, and hemodialyzer sterilization and reuse. On a per-patient basis, these innovations yielded savings from $122 to almost $12 000 but losses of 0.001 to 0.021 quality-adjusted life-years (approximately 8 hours to 1 week). These findings demonstrate the rarity of decrementally cost-effective innovations in the medical literature.

• 出版日期2009-11-3