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[Economic evaluation seeks threshold to support decision-making].

Borja García-Lorenzo, Laura Vallejo-Torres, María Mar Trujillo-Martín

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    Summary
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    Spanish health systems need a formal cost-effectiveness threshold for decision-making. This study critically appraises the current state of research on the quality-adjusted life year (QALY) threshold, proposing future directions.

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    Area of Science:

    • Health Economics
    • Health Policy
    • Decision Analysis

    Background:

    • Economic evaluation requires a defined willingness-to-pay threshold per quality-adjusted life year (QALY).
    • Spain widely cites €30,000/QALY, but lacks formal adoption due to estimation controversies and lack of scientific basis.
    • No universally accepted method exists for determining cost-effectiveness (CE) thresholds in most health systems.

    Purpose of the Study:

    • To critically appraise the current state of research on cost-effectiveness (CE) thresholds in Spain.
    • To assess the utility of CE thresholds in health system decision-making.
    • To propose future research directions for improving CE threshold estimation and application.

    Main Methods:

    • Systematic review of empirical studies on CE threshold estimation.
    • Critical appraisal of the existing literature.
    • Delphi method involving 13 national health economics experts.

    Main Results:

    • Identified significant challenges in the estimation and formal adoption of CE thresholds in Spain.
    • Highlighted the lack of theoretical and scientific basis for commonly cited figures.
    • Confirmed the ongoing debate and need for further research in this area.

    Conclusions:

    • The formal adoption of a cost-effectiveness threshold in Spain remains elusive due to methodological and theoretical limitations.
    • Further research is crucial to establish a scientifically sound and practically useful CE threshold for resource allocation.
    • Improving the estimation and application of CE thresholds will enhance the efficiency of health system decision-making.