HAS THE VALUE OF AN AMERICAN QALY GONE UP? OR IS MEDICARE SPENDING OUT OF LINE WITH OVERALL QALY COSTS?

The Author has frequently written about QALYs, “Quality-Adjusted Life Years”. A QALY is a measure of the rough value of a healthcare treatment or intervention.

The Author has posted several times on QALYs (Quality-Adjusted Life Years). QALYs are a commonly used outcome measurement. And they can be linked to a cost-factor to make cost-utility measurements.

One QALY can be factored as one year of good health. For less than optimal health, quality-adjusted years can be used. For a rough example, consider that a treatment will yield two years of .5 quality of life, or five years of .2 quality of live. In all cases, each treatment will yield one QALY.

A. The intervention yields One year of good health, or one QALY.

B. The intervention yields Two years of .5 quality of life. (2 years * .5) equals one QALY.

C. The intervention yields Five years of .2 quality of life. (5 years * .2) equals one QALY.

$50,000 PER QALY IN AMERICA?

It is the general rule that $50,000 IS a commmonly-recognized figure in America to purchase one QALY. However, a recent article in Time.com cites a recent study that demonstrates that Medicare is paying $129,000 per QALY for kidney dialysis patients.

Stanford economists have demonstrated that the average value of a year of quality human life is actually closer to about $129,000. To get to that number, Stefanos Zenios and his colleagues at Stanford Graduate School of Business used kidney dialysis as a benchmark. Every year dialysis saves the lives of hundreds of thousands of Americans who would otherwise die of renal failure while waiting for an organ transplant. It is also the one procedure that Medicare has covered unconditionally since 1972 despite rapid and sometimes expensive innovations in its administration. To tally the cost-effectiveness of such innovations Zenios and his colleagues ran a computer analysis of more than half a million patients who underwent dialysis, adding up costs and comparing that data to treatment outcomes. Considering both inflation and new technologies in dialysis, they arrived at $129,000 as a more appropriate threshold for deciding coverage. "That means that if Medicare paid an additional $129,000 to treat a group of patients, on average, group members would get one more quality-adjusted life year," Zenios says. Based on patient surveys, one "quality of life" year is defined as about two years of life on dialysis.

Zenios's conclusions arrive amidst mounting debate over whether Medicare, the U.S. government health plan for seniors, ought to use cost-effectiveness analysis in determining coverage of procedures. Nearly all other industrial nations — including Canada, Britain and the Netherlands — ration health care based on cost-effectiveness and the $50,000 threshold. Medicare, on the other hand, decides whether to pay for new technology based on whether a treatment is "medically necessary and appropriate." [AUTHOR’S NOTE: Medicare reimbursement likely reflects the $50,000 QALY figure implicitly. But not explicitly.]But as health care expenses rise and entitlement programs grow fiscally strapped — at least one part of Medicare is now expected to be bankrupt by 2019 — more and more academics have called for this approach to be reconsidered, and for cost to become a factor. Such a move would mean that "if the incremental cost of a new technology was more than the threshold," Zenios says, "then the recommendation would be that Medicare not cover that new technology."

HEALTHCARE RATIONING IN AMERICA? BY THE CRUELEST OF MEASURES.

America is the only western nation that does not have universal coverage. It also spends nearly twice as much per capita to cover those that are fortunate enough to have healthcare coverage. Approximately 15% of Americans, whether by reason of unemployment, inadequate resources, or pre-existing condition, lack health benefits coverage. For those Americans, the options are stark and meager. Heal on your own or die fast.

AS THE AUTHOR FREQUENTLY NOTES, AMERICA IS A YOYOMF ZONE. ALL WE CAN DO IN THE DESERT OF THE REAL IS EXPOSE THE FRAUD AND EXCORIATE THE THIEVES, LIARS AND SONS-OF-BITCHES.