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Tailoring cost-effectiveness to the individual

UPDATE: Scientific American has posted a nice article about this topic on their website this afternoon. Check it out!


Anyone on a budget is familiar with the mental math that precedes any purchasing decision: Is that brand-name paper towel really worth its premium cost? Is it better to buy the large pack of batteries, or only the four that you need right now? If you buy in bulk, how much are you actually saving per item?

Health economists do something similar on a much larger scale as they attempt to calculate what medical interventions are worth. Does a particular surgery, on average, pay for itself in terms of years or quality of life gained? This type of analysis is called incremental cost-effectiveness ratio, and it can be quite useful in figuring out "the big picture" of health-care costs.

The problem, explain Stanford researchers John Ioannidis, MD, DSc, chief of the Stanford Prevention Research Center, and Alan Garber, MD, PhD, in today's issue of PLoS Medicine is that none of us are exactly average.

As described in our release:

According to Ioannidis and Garber, the power of the ICER analysis - that of using large groups of patients to assess the overall effectiveness of particular treatments -- can also make it difficult to apply the outcomes to individual patients. Some people are more risk-adverse than others, for example, making them more likely to shy away from possibly effective medications that bear a small, but not inconsequential, risk of severe side effects. Others with life-limiting conditions may place greater value on a treatment that is likely to keep them alive for a particular event, such as a wedding or a graduation, regardless of the financial cost or side effects.

Incorporating each patient's personal concerns and health status into the standard cost-effectiveness analysis of various treatment options may be the best option for physicians and patients, the researchers conclude.

Previously: Value of disease biomarkers may be exaggerated and Ways to "say no" to wasteful health-care spending
Photo by mynameissharsha

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