From the Guidelines
A good cost for a Quality-Adjusted Life Year (QALY) is typically considered to be less than $50,000, with interventions costing less than this amount generally considered to be high value. This threshold is based on the most recent and highest quality evidence, which suggests that healthcare interventions costing less than $50,000 per QALY gained are generally considered cost-effective 1. The concept of QALY is used to assess the monetary value of a medical intervention, taking into account both the quality and quantity of life lived.
Some of the key factors that influence the cost-effectiveness of a healthcare intervention include:
- The cost of the intervention itself
- The potential benefits of the intervention, including improved health outcomes and quality of life
- The availability of alternative interventions
- The disease severity and equity considerations
For example, a study on the cost-effectiveness of cataract surgery found that the cost per QALY gained was estimated to be around $1,001 in the United States, making it a highly cost-effective intervention 1. In contrast, other medical treatments such as single-vessel coronary artery bare-metal stent for coronary artery disease and total knee arthroplasty have much higher costs per QALY gained, ranging from $13,972 to $15,292 per QALY 1.
It's worth noting that the threshold for a good cost per QALY can vary significantly depending on the country, economic factors, and healthcare system priorities. However, based on the most recent and highest quality evidence, interventions costing less than $50,000 per QALY gained are generally considered to be high value and cost-effective 1.
From the Research
Cost-Effectiveness of QALY
- The cost-effectiveness of a quality-adjusted life year (QALY) is a crucial factor in healthcare decision-making, with various studies suggesting different thresholds for cost-effectiveness 2, 3, 4.
- A study published in 2019 proposed a new probabilistic decision framework to examine non-inferiority in effectiveness and net monetary benefit (NMB) simultaneously, with results showing that the probability of cost-effectiveness varied at different willingness-to-pay (WTP) thresholds, including $0, $50,000, and $100,000 per QALY gained 2.
- Another study from 2000 estimated the value of a QALY using the value-of-life literature, with median values ranging from $24,777 to $428,286 per QALY, depending on the study type 3.
- A 2015 study argued for tiered QALY thresholds of $50,000, $100,000, and $150,000, corresponding to Governmental, Societal, and Health systems analysis perspectives, respectively 4.
Willingness-to-Pay Thresholds
- The willingness-to-pay (WTP) threshold is a critical factor in determining the cost-effectiveness of a QALY, with different studies suggesting various thresholds, including $50,000, $100,000, and $150,000 per QALY gained 2, 3, 4.
- The choice of WTP threshold can significantly impact the probability of cost-effectiveness, as demonstrated by the 2019 study, which showed that the probability of cost-effectiveness varied at different WTP thresholds 2.
QALY Valuation
- The valuation of a QALY is a complex issue, with different studies using various methods to estimate the value of a QALY, including the value-of-life literature and willingness-to-pay thresholds 3, 4.
- The estimated value of a QALY can vary significantly depending on the method used, with median values ranging from $24,777 to $428,286 per QALY, as reported in the 2000 study 3.