Does Medicare have an implicit cost-effectiveness threshold? Med. Decis. Making 2010;published online March 15

Background. Despite the huge cost of the program, the Centers for Medicare and Medicaid Services (CMS) has maintained a policy that cost-effectiveness is not consid-ered in national coverage determinations (NCDs). Objec-tive. To assess whether an implicit cost-effectiveness threshold exists and to determine if economic evidence has been considered in previous NCDs. Methods. A litera-ture search was conducted to identify estimates of cost-effectiveness relevant to each NCD from 1999–2007 (n = 103). The economic evaluation that best represented each coverage decision was included in a review of the cost-effectiveness of medical interventions considered in NCDs. Results. Of the 64 coverage decisions determined to have a corresponding cost-effectiveness estimate, 49 were associated with a positive coverage decision and 1