Systematic overview of cost-effectiveness thresholds in ten countries across four continents

Ruth Schwarzer; Ursula Rochau; Kim Saverno; Beate Jahn; Bernhard Bornschein; Nikolai Muehlberger; Magdalena Flatscher-Thoeni; Petra Schnell-Inderst; Gaby Sroczynski; Martina Lackner; Imke Schall; Ansgar Hebborn; Karl Pugner; Andras Fehervary; Diana Brixner; Uwe Siebert

doi:10.2217/cer.15.38

Systematic overview of cost-effectiveness thresholds in ten countries across four continents

J Comp Eff Res. 2015 Sep;4(5):485-504. doi: 10.2217/cer.15.38.

Authors

Ruth Schwarzer^{1

2}, Ursula Rochau^{1

2}, Kim Saverno^{1

3}, Beate Jahn^{1

2}, Bernhard Bornschein¹, Nikolai Muehlberger¹, Magdalena Flatscher-Thoeni⁴, Petra Schnell-Inderst^{1

2}, Gaby Sroczynski^{1

2}, Martina Lackner¹, Imke Schall¹, Ansgar Hebborn⁵, Karl Pugner⁶, Andras Fehervary⁷, Diana Brixner^{1

2

3

8}, Uwe Siebert^{1

2

9

10}

Affiliations

¹ Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.
² Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria.
³ Department of Pharmacotherapy, University of Utah, 30 South 2000, Salt Lake City, UT 84112, USA.
⁴ Program on Health Policy, Administration, Economics & Law, Department of Public Health & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.
⁵ F Hoffmann-La Roche AG, Market Access Policy, Grenzacher Str. 124, 4070 Basel, Switzerland.
⁶ Amgen, Department of Health Economics & Reimbursement, Dammstrasse 23, 6301 Zug, Switzerland.
⁷ Novartis International AG, Government Affairs Europe, Novartis Campus, Fabrikstrasse 1, 4002 Basel, Switzerland.
⁸ Program in Personalized Health Care, Outcomes Research Center, Department of Pharmacotherapy, University of Utah, 30 South 2000, Salt Lake City, UT 84112, USA.
⁹ Department of Health Policy & Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA 02115, USA.
¹⁰ Institute for Technology Assessment & Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac Street, Boston, MA 02114-4724, USA.

PMID: 26490020
DOI: 10.2217/cer.15.38

Abstract

Aim: To provide an overview of thresholds for incremental cost-effectiveness ratios (ICERs) representing willingness-to-pay (WTP) across multiple countries and insights into exemptions pertaining to the ICER (e.g., cancer). To compare ICER thresholds to individual country's estimated ability-to-pay.

Materials & methods: We included AHRQ/USA, BIQG-GOEG/Austria, CADTH/Canada, DAHTA@DIMDI/Germany, DECIT-CGATS/Brazil, HAS/France, HITAP/Thailand, IQWiG/Germany, LBI-HTA/Austria, MSAC/Australia, NICE/England/Wales and SBU/Sweden. ICER thresholds were derived from systematic literature/website search/expert surveys. WTP was compared with ATP using Spearman's rank correlation.

Results: Two general and explicitly acknowledged thresholds (England/Wales, Thailand), implicit thresholds in six countries and different ICER thresholds/decision-making rules in oncology were identified. Correlation between WTP and ability-to-pay was moderate.

Discussion: Our overview supports country-specific discussions on WTP and on how to define value(s) within societies.

Keywords: cost–effectiveness thresholds; decision-making; health policy; reimbursement; technology assessment; willingness-to-pay.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis / economics*
Cost-Benefit Analysis / statistics & numerical data*
Health Expenditures / statistics & numerical data*
Humans
Internationality*
Quality-Adjusted Life Years