The Limitations of Cost-Effectiveness Analysis in Healthcare Value Assessment

Introduction

Cost-effectiveness analysis (CEA) is a commonly used tool in healthcare value assessment. It aims to compare the costs and benefits of different healthcare interventions to determine their value. However, this article argues that CEA has limitations and may not accurately capture the full value of healthcare interventions.

The Assumption of Homogeneity in Patient Preferences

CEA is based on the assumption that all health outcomes can be measured and valued in terms of quality-adjusted life years (QALYs). However, this assumption fails to account for the heterogeneity of patient preferences. Different patients may value different health outcomes differently, and the QALY metric may not accurately reflect these individual preferences.

Inadequate Consideration of Other Benefits and Costs

CEA typically focuses on the direct health benefits and costs of interventions, but fails to consider other important factors. This includes the impact on caregivers, the broader societal benefits, and the potential for future innovation and learning. By focusing solely on QALYs, CEA may lead to suboptimal decision making and fail to capture the true value of healthcare interventions.

Limitations in the US Healthcare System

The US healthcare system is unique and complex, with a wide range of stakeholders and competing interests. CEA, with its focus on QALYs, may not adequately capture the value of healthcare interventions within this complex system. Additionally, CEA may be influenced by changes in science and medicine, as new treatments and technologies emerge that may not fit neatly into the QALY framework.

Conclusion

In conclusion, CEA, and specifically the use of C/QALY, is not an appropriate tool for value assessment in the context of coverage and reimbursement decision making. It fails to capture the full range of benefits and costs associated with healthcare interventions, and is ill-suited to represent healthcare benefits within the complex nature of the US healthcare system. A more comprehensive and nuanced approach to value assessment is needed to accurately capture the value of healthcare interventions.