Thursday, March 24, 2016

Doing What You Were Not to Do

In a recent Healio piece they describe a study evaluating QALY on PCa. This was frankly expressly prohibited by the ACA for any service provided thereunder. But the cat is out of the bag. The study states:

Under selective therapy, men with lower Gleason scores (< 7) and clinical stage cancer ( T2a) would only receive treatment after clinical progression. All other cases underwent contemporary treatment practices. Key study endpoints included life-years (LY), quality-adjusted life-years (QALY), direct medical expenditures, and cost per LY and QALY gained. Researchers evaluated cost-effectiveness as willingness-to-pay thresholds ranging from $50,000 to $150,000 per QALY. When compared with no screening, all screening strategies increased LYs (range, 0.03-0.06) and costs (range, $263-$1,371). Costs ranged from $7,335 to $21,649 per LY gained.

 Not really clear what was concluded. Was the cost low compared to the benefit? They conclude:

“Our work adds to the growing consensus that highly conservative use of the PSA test and biopsy referral is necessary if PSA screening is to be cost-effective,” Roth and colleagues wrote. “Among the strategies considered, less frequent screening and more restrictive criteria for biopsy resulted in greater chances of PSA screening being cost-effective — particularly when combined with selective treatment strategies that do not immediately treat low-risk, screen-detected cases.”

 This of course is studying on the basis of past practises and having not a clue what causes or differentiates the disease.