Cost-utility analysis (CUA) provides outcomes that are standardised and weighted. The CUA gives rise to a ratio similar to that of a CEA except that the outcomes are measured in quality-adjusted life-years (QALYs). Note that many health services researchers use the two terms CUA and CEA synonymously.4 QALYs reflect both the additional quantity of life that a therapy extends and also the quality of that additional amount of life. The latter measurement is particularly important in fields like dermatology in which therapeutic interventions rarely save lives but often improve qualify of life. In the QALY approach, quality of life is measured by a set of weights called utilities, one for each possible health state, that reflect the relative desirability of the health state. The reader is encouraged to consult other references for a detail explanation of utilities.4,5 By incorporating quality of life and by standardising the outcome measure with QALYs, a dermatology CUA such as acne therapy can be compared with a mortality-impacting CUA such as breast cancer therapy.
Freedberg et al.6 published a CUA comparing a one-time screening strategy for melanoma with a no-screening strategy. They primarily used life-year saved as their outcome measure, but they also used an estimate of utilities to estimate a QALY outcome. They found the CE ratio for the screening programme to be US$29 170 per life-year saved and US$30 360 per QALY. While the strategy of screening once in a lifetime may not mimic reality, the analysis was a good beginning for investigating the cost-effectiveness of melanoma screening. Before interpreting the QALY result (US$30 360 per QALY), readers should realise that the criterion for cost-effectiveness, called the CE threshold, is arbitrary and open to debate. A cost-effective therapy is one that delivers more QALYs per dollar (or costs fewer dollars per QALY) compared with some benchmark. Researchers consider therapies less than US$50 000 per QALY to be relatively cost-effective whereas those greater than US$175 000 per QALY are not.7-9
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