History of the $50k QALY threshold

You’ll find it, and lots of other QALY details and limitations, in “Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold,” by Scott Grosse.

The majority of investigators who used a $50,000 per QALY threshold beginning around 1996 were unclear as to the origin of the practice. Many used this value without citing a source for the practice. Still others cited sources that did not provide either theoretical or empirical support for thresholds of $50,000 per QALY or LY . […]

As Garber and Phelps stated, “The $50,000 criterion is arbitrary and owes more to being a round number than to a well-formulated justification for a specific dollar value”. This could account for the failure of subsequent studies to adjust the value for inflation or changing levels of income or healthcare budgets, a common criticism of the $50,000 per QALY value that applies to any fixed monetary threshold.

Prior, recent, QALY threshold posts here and here. Searching TIE, I found a post defending QALYs from 2011 here. (Yes, it’s by me, but I had no memory of it.) Here’s a well-cited paper on willingness to pay for a QALY I’ve never blogged about (or don’t recall and can’t find evidence of) by Richard Hirth, Michael Chernew, and colleagues.


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