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Comment & Response
Less Is More
March 2015

Using Medicare Data to Understand Health Care Value: Measures of Incremental Cost and Effectiveness are Both Needed to Estimate Value

Author Affiliations
  • 1Department of Orthopaedic Surgery, New York University School of Medicine, New York
  • 2Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York
JAMA Intern Med. 2015;175(3):462. doi:10.1001/jamainternmed.2014.7189

To the Editor The Research Letter by Schmajuk et al1 includes important conceptual errors, which result in an inappropriate conclusion about the value of intra-articular hyaluronic acid injections for treating knee osteoarthritis. Foremost, the authors incorrectly use the term value. Value is specifically defined in health economics as the incremental cost of a treatment divided by its incremental effectiveness.2 Though the authors’ analysis of Medicare costs for intra-articular hyaluronic acid injections is interesting, their analysis does not include a denominator (ie, incremental effectiveness) and therefore cannot allow any estimation of value.

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