Cost Effectiveness Analysis

An economic analysis comparing the relative cost and impact of different medical treatments with the aim of directing health care spending more efficiently.

FDA Restrictions on Mifepristone: Time for a Change?

Issue Brief
Sep. 10, 2020

Mifepristone, a drug used to manage early miscarriage or end an early pregnancy, carries unique restrictions imposed by the U.S. Food and Drug Administration (FDA). Patients are required to pick up the drug in person
from a doctor or a clinic, even though they can take the drug at home. In July, a federal court ruled that the FDA must suspend these restrictions during the COVID-19 pandemic, for patients seeking an early abortion,
although the ruling did not apply to women with an early pregnancy loss. But the challenges to FDA restrictions on mifepristone predate the pandemic. This Issue Brief provides the context for this ongoing controversy, and
reviews recent evidence on the clinical and cost effectiveness of mifepristone for the medical management of first trimester miscarriage.

Association Of Medicare Advantage Penetration With Per Capita Spending, Emergency Department Visits, And Readmission Rates Among Fee-for-Service Medicare Beneficiaries With High Comorbidity Burden

Norma Coe, PhD
Aug. 26, 2020

Sungchul Park, Brent A. Langellier, Robert E. Burke, Jose F. Figueroa, Norma B. Coe

Abstract [from journal]

Rapid growth of Medicare Advantage (MA) plans has the potential to change clinical practice for both MA and fee-for-service (FFS) beneficiaries, particularly for high-need, high-cost beneficiaries with multiple chronic conditions or a costly single condition. We assessed whether MA growth from 2010 to 2017 spilled over to county-level per capita spending, emergency department visits, and readmission rates among FFS beneficiaries, and how much this varied by the comorbidity burden of the beneficiary. We also examined whether the


Health Care Costs of Alzheimer and Related Dementias Within A Medicare Managed Care Provider

Jul. 23, 2020

Paul A. Fishman, Lindsay White, Bailey Ingraham, Sungchul Park, Eric B. Larson, Paul Crane, Norma B. Coe

Abstract [from journal]

Background: Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings.

Objective: The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan.

Research design: A retrospective cohort design was used to estimate direct total, outpatient, inpatient


The Effect Of Increased Cost-Sharing On Low-Value Service Use

Jul. 20, 2020

Jonathan Gruber, Johanna Catherine Maclean, Bill Wright, Eric Wilkinson, Kevin G Volpp

Abstract [from journal]

We examine the effect of a value-based insurance design (VBID) program implemented at a large public employer in the state of Oregon. The program substantially increased cost-sharing for several healthcare services likely to be of low value for most patients: diagnostic services (e.g., imaging services) and surgeries (e.g., spinal surgeries for pain). Using a difference-in-differences design coupled with granular, administrative health insurance claims data over the period 2008-2012, we estimate the change in low-value service use


Cost-Effectiveness of Mifepristone Pretreatment for the Medical Management of Nonviable Early Pregnancy: Secondary Analysis of a Randomized Clinical Trial

Mar. 2, 2020

Divyah Nagendra, Nathanael Koelper, Sandra E. Loza-Avalos, Sarita Sonalkar, Melissa Chen, Jessica Atrio, Courtney A. Schreiber, Heidi S. Harvie

Abstract [from journal]

Importance: Early pregnancy loss (EPL) is the most common complication of pregnancy. A multicenter randomized clinical trial compared 2 strategies for medical management and found that mifepristone pretreatment is 25% more effective than the standard of care, misoprostol alone. The cost of mifepristone may be a barrier to implementation of the regimen.

Objective: To assess the cost-effectiveness of medical management of EPL with mifepristone pretreatment plus misoprostol vs misoprostol alone in the United


Cost-Effectiveness Analysis in Pediatric Imaging: The Evidence (or Lack Thereof) Thus Far

Nov. 29, 2019

Hansel J. Otero, Andrew J. Degna, Nadja Kadom, Peter J. Neumann, Tara A. Lavelle

Abstract [from journal]

Objective: To systematically review all published cost-effectiveness analyses (CEAs) of imaging technologies in children.

Methods: We identified all CEAs involving fetal and pediatric imaging included in a publicly available repository of CEAs published since 1976. Information on publication characteristics, methods, costs, quality of life weights, and incremental cost-effectiveness ratios (ICERs) was recorded for each article.

Results: Of 480 diagnostic CEAs, only 10 focused on fetal


Cost-effectiveness of two opioid use disorder treatments

Dec. 18, 2018

[reposted from the CHERISH blog]

One key strategy in reducing deaths from the opioid epidemic is to improve access to existing evidence-based treatments. Two new economic studies by CHERISH Investigators Drs. Sean Murphy, Kathryn McCollister, and Bruce Schackman can help providers, patients, and payers sort through alternative pharmacotherapies to prevent opioid relapse.

Analysis of Physician Variation in Provision of Low-Value Services

Dec. 3, 2018

Aaron L. Schwartz, Anupam B. Jena, Alan M. Zaslavsky, J. Michael McWilliams

Abstract [from journal] 

Importance: Facing new financial incentives to reduce unnecessary spending, health care organizations may attempt to reduce wasteful care by influencing physician practices or selecting more cost-effective physicians. However, physicians’ role in determining the use of low-value services has not been well described.

Objectives: To quantify variation in provision of low-value health care services among primary care physicians and to estimate the proportion of variation attributable to physician...

Cost-Effectiveness Research in Anesthesiology

Nov. 2, 2018

Bijan J. Teja, Tori N. Sutherland, Sheila R. Barnett, Daniel S. Talmor

Abstract [from journal]

Perioperative interventions aimed at decreasing costs and improving outcomes have become increasingly popular in recent years. Anesthesiologists are often faced with a choice among different treatment strategies with little data available on the comparative cost-effectiveness. We performed a systematic review of the English language literature between 1980 and 2014 to identify cost-effectiveness analyses of anesthesiology and perioperative medicine interventions. We excluded interventions related to critical care or...