Peter J. Neumann, Sc.D., and Joshua T. Cohen, Ph.D.

N Engl J Med 2015; 373:2595­2597 December 31, 2015 DOI: 10.1056/NEJMp1512009

This is an excellent summary of the issues involved in establishing the value of a treatment versus its cost. The case of Sovaldi (sofosbuvir) — the effective but expensive hepatitis C drug — has highlighted this dilemma. Published studies found sofosbuvir “acceptably” cost-effective (i.e., $50,000 to $100,000 per QALY), but already strained budgets could not easily expand to accommodate the costs of making the drug available to several million Americans.