Does Medicare have an implicit cost-effectiveness threshold?
GROUND: Despite the huge cost of the program, the Centers for Medicare and Medicaid Services (CMS) has maintained a policy that cost-effectiveness is not considered in national coverage determinations (NCDs). OBJECTIVE: To assess whether an implicit cost-effectiveness threshold exists and to determine if economic evidence has been considered in previous NCDs. METHODS: A literature search was conducted to identify estimates of cost-effectiveness relevant to each NCD from 1999-2007 (n = 103). The economic evaluation that best represented each coverage decision was included in a review of the cost-effectiveness of medical interventions considered in NCDs. RESULTS: Of the 64 coverage decisions determined to have a corresponding cost-effectiveness estimate, 49 were associated with a positive coverage decision and 15 with a noncoverage decision. Of the positive decisions, 20 were associated with an economic evaluation that estimated the intervention to be dominant (costs less and was more ef
