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Individualized Medical Cost-Effectiveness Metric Proposed

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A physician and health economist at Stanford University School of Medicine in Palo Alto have devised a way to tailor a common measure of medical cost effectiveness for individual decision-making. Their findings appear in the current issue of the journal PLoS Medicine.

John Ioannidis, chief of the Stanford Prevention Research Center, and health economist Alan Garber, who directs the Center for Health Policy at Stanford, have taken a standard medical cost-benefit measure called the incremental cost-effectiveness ratio, or ICER, and proposed a method to more precisely apply it to individuals by assessing the outcome of each treatment on smaller subgroups of patients.

ICER analysis normally uses large groups of patients to assess the overall effectiveness of particular treatments, but this approach can also make it difficult to apply the outcomes to individual patients. Individual factors such as risk tolerance or family priorities can influence the choice of therapies, and need to be respected.

Individualizing ICER would give physicians tools for tailoring treatments to each patient, while also streamlining the decision-making process and keeping overall expenditures as low as possible. “Physicians need to think about what a particular intervention will offer for each patient, and how much it will cost.” says Ioannidis.

The researchers suggest a way to individualize ICER analyses by presenting the outcomes in a per-person format. Rather than presenting the cost of an option on the basis of a per quality-adjusted life year that reflects results from a million patients, physicians should offer the outcome as spending an amount per person to gain a number of days, in terms of the average benefit that a patient could expect to experience from the treatment.

The authors also recommend, when possible, to recalculate ICERs to reflect different experiences of people who might reasonably be expected to differ in their response to certain interventions. Yet, the researchers point out that an individualized ICER has its limitations. It is not appropriate to calculate the individual benefit of population-wide interventions, nor is it useful for measuring the impact of actions, such as vaccinations, which can have an impact on the health of other people.

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