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Title: Illustrating potential efficiency gains from using cost-effectiveness evidence to reallocate Medicare expenditures
Authors: Chambers, JD
Lord, J
Cohen, JT
Neumann, PJ
Buxton, MJ
Keywords: Cost-effectiveness;Disinvestment;Medicare;Resource allocation
Issue Date: 2013
Publisher: Elsevier
Citation: Value in Health, 16(4), 629 - 638, 2013
Abstract: Objectives - The Centers for Medicare & Medicaid Services does not explicitly use cost-effectiveness information in national coverage determinations. The objective of this study was to illustrate potential efficiency gains from reallocating Medicare expenditures by using cost-effectiveness information, and the consequences for health gains among Medicare beneficiaries. Methods - We included national coverage determinations from 1999 through 2007. Estimates of cost-effectiveness were identified through a literature review. For coverage decisions with an associated cost-effectiveness estimate, we estimated utilization and size of the “unserved” eligible population by using a Medicare claims database (2007) and diagnostic and reimbursement codes. Technology costs originated from the cost-effectiveness literature or were estimated by using reimbursement codes. We illustrated potential aggregate health gains from increasing utilization of dominant interventions (i.e., cost saving and health increasing) and from reallocating expenditures by decreasing investment in cost-ineffective interventions and increasing investment in relatively cost-effective interventions. Results - Complete information was available for 36 interventions. Increasing investment in dominant interventions alone led to an increase of 270,000 quality-adjusted life-years (QALYs) and savings of $12.9 billion. Reallocation of a broader array of interventions yielded an additional 1.8 million QALYs, approximately 0.17 QALYs per affected Medicare beneficiary. Compared with the distribution of resources prior to reallocation, following reallocation a greater proportion was directed to oncology, diagnostic imaging/tests, and the most prevalent diseases. A smaller proportion of resources went to cardiology, treatments (including drugs, surgeries, and medical devices, as opposed to nontreatments such as preventive services), and the least prevalent diseases. Conclusions - Using cost-effectiveness information has the potential to increase the aggregate health of Medicare beneficiaries while maintaining existing spending levels.
Description: This article is available open access through the publisher’s website at the linke below. Copyright @ 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
This article has been made available through the Brunel Open Access Publishing Fund.
ISSN: 1098-3015
Appears in Collections:Brunel OA Publishing Fund
Health Economics Research Group (HERG)
Dept of Life Sciences Research Papers

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