A health economist compares two screening programmes for diabetic retinopathy. Programme A costs Rs 50 lakh per year and gains 400 quality-adjusted life years (QALYs); Programme B costs Rs 80 lakh per year and gains 500 QALYs. The incremental cost-effectiveness ratio (ICER) of Programme B over Programme A is:

• A Rs 12,500 per QALY gained
• B Rs 16,000 per QALY gained
• C Rs 30,000 per QALY gained ✓
• D Rs 2,000 per QALY gained

Explanation

ICER equals the difference in cost divided by the difference in effect between two alternatives. Here the cost difference is Rs 80 lakh minus Rs 50 lakh, that is Rs 30 lakh, and the effect difference is 500 minus 400, that is 100 QALYs. Rs 30,00,000 divided by 100 gives Rs 30,000 per additional QALY. Option B divides total cost of B by total effect, option A divides cost difference by effect of B alone, and option D divides neither correctly.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.