Journal
VALUE IN HEALTH
Volume 19, Issue 5, Pages 558-566Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jval.2016.02.020
Keywords
cost-effectiveness analysis; quality-adjusted life-year; threshold
Funding
- Ministry of Health, Social Services and Equality
- Carlos III Health Institute
- Ministry of Economics and Competitiveness
- Canary Islands Foundation of Research and Health (FUNCIS)
- Improving Biomedical Research in the Canary Islands (IMBRAIN) project under the 7th Framework Programme (Capacities) [FP7-REGPOT-2012-CT2012-31637-IMBRAIN]
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Background: Many health care systems claim to incorporate the cost-effectiveness criterion in their investment decisions. Information on the system's willingness to pay per effectiveness unit, normally measured as quality-adjusted life-years (QALYs), however, is not available in most countries. This is partly because of the controversy that remains around the use of a cost-effectiveness threshold, about what the threshold ought to represent, and about the appropriate methodology to arrive at a threshold value. Objectives: The aim of this article was to identify and critically appraise the conceptual perspectives and methodologies used to date to estimate the cost-effectiveness threshold. Methods: We provided an in-depth discussion of different conceptual views and undertook a systematic review of empirical analyses. Identified studies were categorized into the two main conceptual perspectives that argue that the threshold should reflect 1) the value that society places on a QALY and 2) the opportunity cost of investment to the system given budget constraints. Results: These studies showed different underpinning assumptions, strengths, and limitations, which are highlighted and discussed. Furthermore, this review allowed us to compare the cost-effectiveness threshold estimates derived from different types of studies. We found that thresholds based on society's valuation of a QALY are generally larger than thresholds resulting from estimating the opportunity cost to the health care system. Conclusions: This implies that some interventions with positive social net benefits, as informed by individuals' preferences, might not be an appropriate use of resources under fixed budget constraints.
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