0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

Cost-effective Primary Care–Based Strategies to Improve Smoking Cessation—Invited Commentary

Patrick G. O’Malley, MD, MPH
Arch Intern Med. 2009;169(3):235-236. doi:10.1001/archinternmed.2008.534.
Text Size: A A A
Published online

Extract

Cost-effectiveness is getting more attention these days, and the burgeoning number of publications on this subject as well as the increased attention to medical accountability in terms of effectiveness and cost make it important that we all understand how to interpret cost-effectiveness analyses. This is easier said than done because reading the literature on cost-effectiveness is like navigating through the Tower of Babel.

Cost-effectiveness boils down to value for money. Some interventions may be very expensive but well worth it (eg, bypass grafting in patients with 3-vessel obstructive coronary artery disease and depressed left ventricle function), whereas others may be cheap but wasteful because they simply do not work (eg, taking vitamin E for the prevention of coronary artery disease). In mathematical terms, the key quotient is the incremental cost per incremental clinical benefit (Δ cost/Δ life expectancy or preferably quality-adjusted life expectancy; ie, comparing 2 alternative treatment strategies modeled out to a typical lifetime from a societal perspective). But how do we determine which interventions are truly worth the cost? The most basic conventional litmus test of this in the United States is what payers such as Centers for Medical and Medicaid Services or other financers of health care (such as Blue Cross Blue Shield) are willing to pay, and this is in the range of $50 000 to $100 000 additional cost per additional quality-adjusted life-year (QALY). Even this willingness-to-pay threshold is affected by many other (including political) factors. From a global perspective, it depends on a nation's wealth, which directly affects willingness to pay. A poor nation, for example, may only be able to afford cost-saving interventions such as vaccination programs or water treatment interventions, whereas certain sectors of the United States are even willing to pay for expensive screening programs that, using conservative assumptions, likely cost over $1 million per additional life-year saved, or possibly even infinite costs in situations in which the marginal benefit is unknown and possibly nil.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();