What’s Been The Bang For The Buck? Cost-Effectiveness Of Health Care Spending Across Selected Conditions In The US

Wamble, David; Ciarametaro, Michael; Houghton, Katherine; Ajmera, Mayank; Dubois, Robert W.

doi:10.1377/hlthaff.2018.05158

Cited by 6 publications

(9 citation statements)

References 17 publications

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“…The literature finds average branded pharmaceutical prices set to yield cost-effectiveness ratios well below our reference point of 0.67. 2,18,19 Furthermore, we observe low consumer coinsurance and co-payments. A Kaiser Family Foundation survey of US employee health benefits found that 39% of employees had coinsurance coverage for drugs and that conditional on having coinsurance, the rate varied between 19% and 31%, depending on tier.…”

Section: Does Practice Match Theory?mentioning

confidence: 65%

Cost-Effectiveness Analysis of Branded Drugs With Market Demand and Insurance

et al. 2021

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Objectives: Cost-effectiveness analysis of branded pharmaceuticals presumes that both cost (or price) and marginal effectiveness levels are exogenous. This assumption underlies most judgments of the cost-effectiveness of specific drugs. In this study, we show the theoretical implications of letting both factors be endogenous by modeling pharmaceutical price setting with and without health insurance, along with patient response to the prices that depend on marginal effectiveness. We then explore the implications of these models for cost-effectiveness ratios.Methods: We used simple textbook models of patient demand and pricing behavior of drug firms to predict market equilibria in the drug and insurance markets and to generate calculations of the cost-effectiveness ratios in those settings.Results: We found that ratios in market settings can be much different from those calculated in cost-effectiveness studies based on exogenous prices and treatment of all patients at risk rather than those who would demand treatment in a market setting. We also found that there may be considerable similarity in these market cost-effectiveness ratios across different products because drug firms with market power set profit-maximizing prices. Conclusions:We found that market cost-effectiveness ratios will always indicate an excess of benefits over cost. Insurance will lead to less favorable ratios than without insurance, but when insurers bargain with drug firms, rather than taking their prices as given, cost-effectiveness ratios will be more favorable.

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Section: Does Practice Match Theory?mentioning

confidence: 65%

Cost-Effectiveness Analysis of Branded Drugs With Market Demand and Insurance

et al. 2021

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“…33,34 This suggests an opportunity for continued improvement in the value of post-stroke care in the US, where investments in prevention and management of cerebrovascular diseases have resulted in cost savings and improved health among US patients with cerebrovascular disease. 35 This study has some limitations. GWTG-Stroke participation is voluntary, and participating hospitals may provide higher quality stroke care than non-participating hospitals, resulting in higher rates of discharge to home, lower mortality rates, and potentially lower costs.…”

Section: Discussionmentioning

confidence: 91%

Disease Burden Following Non-Cardioembolic Minor Ischemic Stroke or High-Risk TIA: A GWTG-Stroke Study

Kaufman

Shah

Hellkamp

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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Background: Limited real-world data are available on outcomes following non-cardioembolic minor ischemic stroke (IS) or high-risk transient ischemic attack (TIA), particularly in the United States (US). We examined outcomes and Medicare payments following any severity IS or TIA as well as the subgroup with minor IS or high-risk TIA. Methods: Medicare beneficiaries >65 years were identified using US nationwide Get with the Guidelines (GWTG)-Stroke Registry linked to Medicare claims data. The cohort consisted of patients enrolled in Medicare fee-for-service plan, hospitalized with non-cardioembolic IS or TIA between 2011 and 2014, segmenting a subgroup with minor IS (National Institute of Health Stroke Scale [NIHSS] 5) or high-risk TIA (ABCD 2-score 6) compatible with the THALES clinical trial population. Outcomes included functional status at discharge, clinical outcomes (all-cause mortality, ischemic stroke, and hemorrhagic stroke, individually and as a composite), hospitalizations, and population average inpatient Medicare payments following non-cardioembolic IS or TIA. Results: The THALES-compatible cohort included 62,518 patients from 1471 hospitals. At discharge, 37.0% were unable to ambulate without assistance, and 96.2% were prescribed antiplatelet therapy. Cumulative incidences at 30 days, 90 days, and 1 year for the composite outcome were 3.7%, 7.6%, and 17.2% and 2.4%, 4.0%, and 7.3% for subsequent stroke. The mean Medicare payment for the index hospitalization was $7951. The cumulative all-cause inpatient Medicare spending per patient (with or without any subsequent admission) at 30 days and 1 year from discharge was $1451 and $8105, respectively. Conclusions: The burden of illness for minor IS/high-risk TIA patients indicates an important unmet need. Improved therapeutic options may offer a significant impact on both patient outcomes and Medicare spending.

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“…The value of health spending could also Several other studies assessed changes in spending on specific conditions or groups of conditions, often finding that accounting for quality change reduced the spending increase or led to a decline in the quality-adjusted cost of treatment (e.g. Lakdawalla et al 2015;Wamble et al 2019). Net value is similar to the "quality-adjusted cost of care" proposed by Lakdawalla et al (2015), which is "cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival."…”

Section: Discussionmentioning

confidence: 99%

“…Our finding that the quality-adjusted "cost of living" medical price index for managing diabetes has been declining across all four health systems is robust to various sensitivity analyses accounting for selective survival, end-of-life spending, and a range of values for a life-year or percentage of survival benefits attributable to medical spending. We discuss comparisons with earlier studies using this methodology in the U.S. (Eggleston et al 2009) as well as related studies using different methods and studying other conditions (Cutler and McClellan 2001;Shapiro et al 2001;Berndt et al 2002;Highfell and Bernstein 2014;Dunn et al 2018;Wamble et al 2019). In sum, empirical evidence suggests that increased medical spending is "worth it" on average, although productivity surely could be further enhanced by increasing high-value care and reducing low-value care.…”

mentioning

confidence: 91%