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Using threshold values for cost per quality-adjusted life-year gained in healthcare decisions

Published online by Cambridge University Press:  25 January 2011

Irina Cleemput ,
Mattias Neyt ,
Nancy Thiry ,
Chris De Laet  and
Mark Leys
Irina Cleemput
Affiliation:
Belgian Health Care Knowledge Centre (KCE) and Katholieke Universiteit Leuven
Mattias Neyt
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Nancy Thiry
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Chris De Laet
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Mark Leys
Affiliation:
Belgian Health Care Knowledge Centre (KCE) and Vrije Universiteit Brussel
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Abstract

Background: In many countries, the incremental cost-effectiveness ratio (ICER) is used to assess whether an intervention is worth its costs. At the same time, policy makers often feel uncomfortable with refusing reimbursement of any intervention purely on the basis of the fact that the ICER exceeds a specific threshold value. Reluctance to define a single threshold value for the ICER seems to have been stronger in social security systems than in national healthcare services systems. This study explores how basic differences between healthcare systems impact upon the potential usefulness of an ICER threshold value.

Methods: This study is a narrative review of literature about the theoretical foundations of the ICER threshold value approach and its practical relevance in different types of healthcare systems.

Results: A single ICER threshold value cannot be maintained, defined, or measured and should not be used as a policy-making tool. None of the solutions presented up until now to make the ICER threshold approach a valuable policy-making tool overcome the important weaknesses of the approach.

Conclusions: ICERs and ICER threshold values are insufficient for assessing interventions' value for money. Rather, they should be considered as one element in the decision-making process. Complete rationalization of the decision-making process by means of quantitative decision criteria is undesirable and not feasible. Increasing transparency in the criteria used for a decision and explicitness about the relative importance of each criterion should, therefore, be the major goal.

Keywords

Cost-effectiveness AnalysisDecision makingHealthcare rationing/economicsQuality-adjusted life yearsHealthcare costs
Type
METHODS
Information
International Journal of Technology Assessment in Health Care , Volume 27 , Issue 1 , January 2011 , pp. 71 - 76
Copyright
Copyright © Cambridge University Press 2011

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References

REFERENCES

1. Bleichrodt, H, Diecidue, E, Quiggin, J. Equity weights in the allocation of health care: The rank-dependent QALY model. J Health Econ. 2004;23:157–171.CrossRefGoogle ScholarPubMed
2. Brouwer, WB, Koopmanschap, MA. On the economic foundations of CEA. Ladies and gentlemen, take your positions! J Health Econ. 2000;19:439–459.CrossRefGoogle ScholarPubMed
3. Cleary, SM, McIntyre, D, Boulle, AM. The cost-effectiveness of antiretroviral treatment in Khayelitsha, South Africa–a primary data analysis. Cost Eff Resour Alloc. 2006;4:20.CrossRefGoogle ScholarPubMed
4. Cleemput, I, Neyt, M, Thiry, N, De Laet, C, Leys, M. Threshold values for cost-effectiveness in health care. Belgian Health Care Knowledge Centre. HTA reports. Brussels: KCE; 2008:88.Google Scholar
5. Coast, J. Is economic evaluation in touch with society's health values? BMJ. 2004;329:1233–1236.CrossRefGoogle ScholarPubMed
6. Culyer, A, McCabe, C, Briggs, A, et al. Searching for a threshold, not setting one: The role of the National Institute for Health and Clinical Excellence. J Health Serv Res Policy. 2007;12:56–58.CrossRefGoogle Scholar
7. Devlin, N, Parkin, D. Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis. Health Econ. 2004;13:437–452.CrossRefGoogle ScholarPubMed
8. Dolan, P. Utilitarianism and the measurement and aggregation of quality–adjusted life years. Health Care Anal. 2001;9:65–76.CrossRefGoogle ScholarPubMed
9. Dolan, P, Shaw, R, Tsuchiya, A, Williams, A. QALY maximisation and people's preferences: A methodological review of the literature. Health Econ. 2005;14:197–208.CrossRefGoogle ScholarPubMed
10. Dolan, P, Edlin, R, Tsuchiya, A. The relative societal value of health gains to different beneficiaries. http://www.pcpoh.bham.ac.uk/publichealth/methodology/projects/RM03_JH11_PD.shtml (accessed 2008).Google Scholar
11. Dowie, J. Why cost-effectiveness should trump (clinical) effectiveness: The ethical economics of the South West quadrant. Health Econ. 2004;13:453–459.CrossRefGoogle ScholarPubMed
12. Drummond, M, Brown, R, Fendrick, AM, et al. Use of pharmacoeconomics information–report of the ISPOR Task Force on use of pharmacoeconomic/health economic information in health-care decision making. Value Health. 2003;6:407–416.CrossRefGoogle ScholarPubMed
13. Drummond, M, Sculpher, M, Torrance, G, O'Brien, B, Stoddart, G. Methods for the economic evaluation of health care programmes (3rd ed.). Oxford: Oxford University Press; 2005.CrossRefGoogle Scholar
14. Gafni, A, Birch, S. Incremental cost-effectiveness ratios (ICERs): The silence of the lambda. Soc Sci Med. 2006;62:2091–2100.CrossRefGoogle ScholarPubMed
15. Grosse, SD, Teutsch, SM, Haddix, AC. Lessons from cost-effectiveness research for United States public health policy. Annu Rev Public Health. 2007;28:365–391.CrossRefGoogle ScholarPubMed
16. Hoffmann, C, Graf von der Schulenburg, JM. The influence of economic evaluation studies on decision making. A European survey. The EUROMET group. Health Policy. 2000;52:179–192.CrossRefGoogle ScholarPubMed
17. King, JT Jr, Tsevat, J, Lave, JR, Roberts, MS. Willingness to pay for a quality-adjusted life year: Implications for societal health care resource allocation. Med Decis Making. 2005;25:667–677.CrossRefGoogle ScholarPubMed
18. Mitton, C, Donaldson, C. Health care priority setting: Principles, practice and challenges. Cost Eff Resour Alloc. 2004;2:3.CrossRefGoogle ScholarPubMed
19. National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. London: NICE; 2008:80.Google Scholar
20. Raftery, J. NICE and the challenge of cancer drugs. BMJ. 2009;338:b67.CrossRefGoogle ScholarPubMed
21. Raftery, J. Should NICE's threshold range for cost per QALY be raised? No. BMJ. 2009;338:b185.CrossRefGoogle ScholarPubMed
22. Rawlins, MD, Culyer, AJ. National Institute for Clinical Excellence and its value judgments. BMJ. 2004;329:224–227.CrossRefGoogle ScholarPubMed
23. Stolk, EA, van Donselaar, G, Brouwer, WB, Busschbach, JJ. Reconciliation of economic concerns and health policy: Illustration of an equity adjustment procedure using proportional shortfall. Pharmacoeconomics. 2004;22:1097–1107.CrossRefGoogle ScholarPubMed
24. Thiry, N, De Laet, C, Hulstaert, F, et al. Cost-effectiveness of human papillomavirus vaccination in Belgium: Do not forget about cervical cancer screening. Int J Technol Assess Health Care. 2009;25:161–170.CrossRefGoogle Scholar
25. Towse, A. Should NICE's threshold range for cost per QALY be raised? Yes. BMJ. 2009;338:b181.CrossRefGoogle ScholarPubMed
26. Tsuchiya, A, Dolan, P. The QALY model and individual preferences for health states and health profiles over time: A systematic review of the literature. Med Decis Making. 2005;25:460–467.CrossRefGoogle Scholar
27. Tsuchiya, A, Dolan, P. Equality of what in health? Distinguishing between outcome egalitarianism and gain egalitarianism. Health Econ. 2009;18:147–159.CrossRefGoogle ScholarPubMed
28. van der Zee, J, Kroneman, MW. Bismarck or Beveridge: A beauty contest between dinosaurs. BMC Health Serv Res. 2007;7:94.CrossRefGoogle ScholarPubMed
29. Weinstein, M, Zeckhauser, R. Critical ratios and efficient allocation. Journal of Public Economics. 1973;2:147–157.CrossRefGoogle Scholar
30. Weinstein, MC, Stason, WB. Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med. 1977;296:716–721.CrossRefGoogle ScholarPubMed
31. Williams, A. Is the QALY a technical solution to a political problem? Of course not! Int J Health Serv. 1991;21:365–369; discussion 371–372.CrossRefGoogle ScholarPubMed
32. Williams, A. What could be nicer than NICE? London: Office of Health Economics; 2004.Google Scholar
33. Williams, I, Bryan, S, McIver, S. How should cost-effectiveness analysis be used in health technology coverage decisions? Evidence from the National Institute for Health and Clinical Excellence approach. J Health Serv Res Policy. 2007;12:73–79.CrossRefGoogle ScholarPubMed