Table 6.
Cost per Quality-Adjusted Life Year (QALY) gained from selected clinical strategies (results of this study are in bold)
| Intervention | ICER ($/QALY) |
|---|---|
| Corticosteroids vs. nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with any disease-modifying anti-rheumatic drug (DMARD) in patients with rheumatoid arthritis (age 50)57 | Cost saving |
| Aspirin vs. no aspirin in combination with usual care in patients at high risk for cardiovascular disease58 | $2,840 |
| Mechanical thrombectomy vs. best medical therapy alone in patients with large-vessel ischemic stroke who are ineligible to receive tissue plasminogen activator (age 67)59 | $12,120 |
| CPAP therapy vs. no treatment in patients with a diagnosis of moderate-to-severe OSA (50-year-old male) | $15,915 |
| Full-night polysomnography and initiation of CPAP therapy vs. no diagnosis and no treatment for the diagnosis of OSA in patients with 50% pretest probability of OSA (50-year-old male) | $17,131 |
| Annual screening for proteinuria and subsequent treatment with ACE inhibitor or ARB therapy vs. routine clinical practice (No Screening) in patients with hypertension at annual physical (age 50)60 | $21,880 |
| Diabetes screening vs. routine clinical practice (no Screening) in patients with hypertension at annual physical (age 55)61 | $44,100 |
| Pioglitazone vs. placebo, in addition to usual care in high-risk patients with type 2 diabetes62 | $47,770 |
| Adult Treatment Panel III (ATP III) guidelines vs. alternate risk and age based strategies for identifying patients for cholesterol lowering statin therapy in the general population (ages 35-85)63 | $48,265 |
| Ileocolonoscopy with follow-up computed tomographic enterography (CTE) vs. ileocolonoscopy only for the diagnosis of small-bowel Crohn disease in patients with 75% pretest probability of small-bowel Crohn disease (30 year old)64 | $55,390 |
| HIV antibody screening every 5 years vs. one-time screening, for the diagnosis of HIV in general population with 1% pretest probability of HIV (age 42)65 | $63,900 |
| Annual mammogram from ages 40 to 80 vs. annual mammogram from ages 45 to 80 for the diagnosis of breast cancer in average risk women in the general population66 | $71,000 |
| Bone densitometry vs. no densitometry for the diagnosis of osteoporosis and fracture risk assessment in men with no history of clinical fracture (age 70)67 | $103,750 |
| One-time whole-body CT scan vs. routine preventive care at age 5068 | $180,500 per LY-gained |
| Dynamic susceptibility-weighted contrast material-enhanced (DSC) magnetic resonance (MR) imaging vs. standard clinical workup for the diagnosis of Alzheimer disease In community dwelling patients with mild to moderate dementia69 | $749,000 |
Values are given in 2008 U.S. dollars, with adjustment using the GDP deflator. Numbers are the ratios of the added cost per person to the gain in QALYs per person.