A Perspective paper:

Updating Cost-Effectiveness — The Curious Resilience of the $50,000-per-QALY Threshold
Peter J. Neumann, Sc.D., Joshua T. Cohen, Ph.D., and Milton C. Weinstein, Ph.D.

New Englangd Journal of Medicine, 2014; 371:796-797
Published August 28, 2014
DOI: 10.1056/NEJMp1405158


“For more than two decades, the ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has played an important if enigmatic role in health policy circles as a benchmark for the value of care. Researchers have summoned this cost-effectiveness ratio in order to champion or denounce particular investments in medical technologies and health programs. Critics, meanwhile, have argued that the ratio is misunderstood and misused.

The fact that the $50,000-per-QALY yardstick has persisted attests to the medical community’s need for a value threshold and to the advantages enjoyed by incumbents. It has endured even as the United States has legislated against the explicit use of cost-per-QALY thresholds, and it has held its own even though common sense might dictate that it should be updated to reflect inflation and economic growth. ….”