Abstract

Objectives

This study aims to reperform cost-effective analyses (CEAs) that informed American Heart Association (AHA) guidelines between 2014 and 2022 using the health years in total (HYT) instead of the quality-adjusted life-year (QALY) to quantify the extent to which value assessment conclusions would change using a different metric.

Methods

We reanalyzed 21 CEAs that were referenced in clinical practice recommendations in AHA guidelines between 2014 and 2022. We then compared value conclusions based on cost-per-HYT with cost-per-QALY CEA results and assessed whether the change in metric affected value assessment classifications within the AHA-identified categories of high-, intermediate-, and low-value care (using $50 000/QALY and $150 000/QALY thresholds). In a sensitivity analysis, we applied an additional $100 000/QALY threshold to further subdivide intermediate-value care into intermediate-high and intermediate-low subcategories.

Results

There were 48 incremental cost-effectiveness ratios (ICERs) used to inform the AHA guidelines across the 21 CEAs we reanalyzed. We found that 96% of the value assessments classifications (46/48 ICERs) used in AHA clinical practice guidelines in 2014 to 2022 remained unchanged whether using QALY or HYT, with 90% (43/48 ICERs) remaining unchanged in the sensitivity analysis using the $100 000/QALY threshold.

Conclusions

We found a strong correlation between value assessments based on CEAs using the QALY versus the same CEA reanalyzed using the HYT. These findings suggest that current AHA recommendations would remain largely unaffected if they were informed by the HYT, a QALY alternative that does not discriminate against individuals at lower baseline health.