The additional dimensions captured in assessments of health-related quality of life could be particularly useful in evaluating services for the Medicare population in which chronic disease is so prevalent. For example, two interventions might be equally effective in extending survival, but they might differ in the extent to which the extra years of life were lived with or without pain or serious limitations in physical or mental functioning. A number of methods and tools have been developed to assess health-related quality of life including methods for assessing people’s preferences for different health states (e.g., a year of life lived in severe pain versus nine months lived pain free).

Although formal cost-effectiveness analyses are useful in trying to understand the “value for money” of particular interventions, the committee’s charge called only for estimates of the costs to Medicare of extending coverage. Even if the committee had gone further, it would have encountered difficulties given the limited evidence of effectiveness and the lack of quality-of-life or patient preference data for the interventions examined. Studies have compared health-related quality of life for patients on renal dialysis with posttransplant patients taking immunosuppressive drugs, but the committee did not find comparable data on the other conditions considered here. Nonetheless, the approach used here—estimating only the costs to Medicare—provides an incomplete picture of the value for money of covering a service.

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