PharmacoEconomics & Outcomes News 554 - 31 May 2008 How much should we be willing to pay? How much are we – and should we be – willing to pay, as a society, for improving health outcomes? This is the question posed by researchers from the Stanford Graduate School of Business and the Wharton Business School. Their study found that, rather than the commonly used international threshold of $US50 000 per QALY gained for making allocation decisions about medical interventions, a more realistic figure for the US is probably at least $US129 000. In contrast to other countries such as the UK and Australia, the US Medicare system typically makes decisions on the basis of whether a treatment is ‘medically necessary and appropriate’, without explicit cost considerations. This may not be feasible in the long term. The researchers estimated the $US129 000 threshold for making Medicare coverage decisions by running computer models using data from over half a million patients who underwent kidney dialysis. However, the researchers say that using such a threshold would lead to profound ethical dilemmas; "applying the $129,000 threshold in a very sharp way for specific groups and individuals would mean that the sickest subgroups of patients would be denied access to expensive treatments". They argue that any thresholds should be applied in keeping with the principles of social justice in which resources are allocated to benefit everyone. Stanford Graduate School of Business. Putting Dollar Value on Extending Life Poses Ethical Dilemma According to Stanford Business School Research. Media Release : 16 May 2008. Available from: URL: http:// 809089052 www.gsb.stanford.edu

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PharmacoEconomics & Outcomes News 31 May 2008 No. 554

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