News Release

Defining cost-effectiveness thresholds is a critical step in decisions about health care spending

Embargoed news from Annals of Internal Medicine

Peer-Reviewed Publication

American College of Physicians

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. Defining cost-effectiveness thresholds is a critical step in decisions about health care spending



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A modeling study shows that treatments with incremental cost-effectiveness ratios (ICERs) above the range of $100,000 to $150,000 per quality-adjusted life-year (QALY) are unlikely to be considered cost-effective for the United States health care system. Establishing cost-effectiveness is important for informing policy considerations, clinical guidelines, insurance coverage, and drug prices. The findings are published in Annals of Internal Medicine.

The U.S. health care system readily adopts and pays for costly new treatments without requiring improvements in health outcomes to justify those costs. Spending less on treatments that offer little or no improvement in outcomes would allow more spending on other treatments that may offer larger health gains without increasing the overall health care budget. However, no consensus exists about what the cost threshold should be in relation to health improvements gained.

Using model inputs from demographic data and published literature, researchers from Pennsylvania State University and the University of York created a computer simulation to estimate a U.S. cost-effectiveness threshold based on health opportunity costs. Their model estimated how many people would drop insurance coverage if premiums were increased to pay for a costly new treatment. They then estimated the effects that loss of insurance would have on population morbidity and mortality, finding that for about every $104,000 in additional health care costs, one QALY would be lost. Available evidence suggests a 14 percent probability that the threshold for cost-effectiveness exceeds $150,000 per QALY and about 48 percent probability that it lies below $100,000 per QALY.

According to the author of an accompanying editorial from the Institute for Clinical and Economic Review, Boston, this work is important because health care needs to help not only the patients in the room but also the patients who will be affected by how a decision to spend resources on one health care intervention affects resources available to direct to other interventions. Policymakers, clinicians, and the public need to recognize that when prices for services exceed a certain cost in relation to their benefits, real harm comes to the system overall.

Media contacts: For an embargoed PDF, please contact Lauren Evans at To reach the corresponding author, David J. Vanness, PhD, please contact Scott Sheaffer at

2. New review offers evidence-based advice for addressing cannabis use and cannabis use disorder


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A new review provides practical advice for physicians on how to care for patients using cannabis and those with cannabis use disorder. The review offers evidence-based answers to frequently asked questions about cannabis use, including the health consequences, medical benefits, legal issues, and available treatments. In the Clinic: Care of the Patient Using Cannabis is published in Annals of Internal Medicine.

The past 20 years have witnessed an explosion nationwide in legal access to cannabis and cannabis-derived products for medical and recreational purposes. With expanded legal access, there has been great concern that use, especially among adolescents, could increase, fueling the pipeline of addiction. In addition, increased availability of edible cannabis-derived products sparks fears of child poisonings and public intoxication, such as drugged driving.

The authors from New York State Psychiatric Institute, Columbia University, and Beth Israel Deaconess Medical Center and Harvard Medical School present the evidence and offer advice on how to treat the medical and psychological issues related to cannabis use, especially when use becomes problematic. Currently, millions of adults now meet the criteria for cannabis use disorder in a given year, and all clinicians have a vital role in improving clinical management from screening and diagnosis to overseeing treatment plans, according to the authors. While there are no medications specifically approved for cannabis use disorder, the authors provide advice for the pharmacological and psychotherapeutic treatments available to practitioners.

Media contacts: For an embargoed PDF, please contact Lauren Evans at To reach the corresponding author, Robin Williams, MD, please contact Gregory Flynn at

Also in this issue:

Should Race Be Part of Glomerular Filtration Rate Estimation?
Robert M. Centor, MD
Annals On Call

2015 vs 2020
Grace E. Farris, MD
Graphic Medicine


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