How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations.

TLDR

Economic evaluations of health care services are increasingly published, necessitating rigorous assessment and comparison of net benefits, with technologies graded from A (more effective and cheaper) to E (less or equal effectiveness and more costly), while recognizing that ethical, political, and other non‑cost factors also influence implementation. The authors propose four levels of evidence to rate economic evaluations by methodological rigor, aiming to provide a framework that aids interpretation and informs decisions on adopting and utilizing health care services. The grading system relies on the quality of methods estimating clinical effectiveness, quality of life, and costs, using incremental net benefit magnitude to classify therapies into five recommendation grades, with grade B below $20,000/QALY, grade C between $20,000–$100,000/QALY, and grade D above $100,000/QALY.

Abstract

Because economic evaluations of health care services are being published with increasing frequency it is important to (a) evaluate them rigorously and (b) compare the net benefit of the application of one technology with that of others. Four "levels of evidence" that rate economic evaluations on the basis of their methodologic rigour are proposed. They are based on the quality of the methods used to estimate clinical effectiveness, quality of life and costs. With the use of the magnitude of the incremental net benefit of a technology, therapies can also be classified into five "grades of recommendation." A grade A technology is both more effective and cheaper than the existing one, whereas a grade E technology is less or equally effective and more costly. Those of grades B through D are more effective and more costly. A grade B technology costs less than $20,000 per quality-adjusted life-year (QALY), a grade C one $20,000 to $100,000/QALY and a grade D one more than $100,000/QALY. Many issues other than cost effectiveness, such as ethical and political considerations, affect the implementation of a new technology. However, it is hoped that these guidelines will provide a framework with which to interpret economic evaluations and to identify additional information that will be useful in making sound decisions on the adoption and utilization of health care services.