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On the Estimation of the Cost-Effectiveness Threshold: Why, What, How?
Laura Vallejo-Torres1, Borja García-Lorenzo2, Iván Castilla3
1Departamento de Economía Aplicada y Métodos Cuantitativos, Universidad de la Laguna; Centre for Biomedical Research of the Canary Islands (CIBICAN); Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Department of Applied Health Research, University College London, London, UK.
Determining the cost-effectiveness threshold is complex. Thresholds based on societal value for quality-adjusted life-years (QALYs) are typically higher than those based on healthcare system opportunity costs.
Area of Science:
- Health economics
- Health policy analysis
- Decision science
Background:
- Healthcare systems often claim to use cost-effectiveness in investments.
- Willingness to pay per quality-adjusted life-year (QALY) data is often unavailable.
- Controversy exists regarding the definition and methodology for cost-effectiveness thresholds.
Purpose of the Study:
- To identify and critically appraise conceptual perspectives on cost-effectiveness thresholds.
- To review methodologies used for estimating cost-effectiveness thresholds.
Main Methods:
- In-depth discussion of conceptual views.
- Systematic review of empirical analyses.
- Categorization of studies into societal valuation and opportunity cost perspectives.
Main Results:
- Studies revealed diverse assumptions, strengths, and limitations.
- Thresholds based on societal QALY valuation are generally higher.
- Thresholds derived from opportunity costs are generally lower.
Conclusions:
- Societal valuation and opportunity cost perspectives yield different threshold estimates.
- Interventions with positive social net benefits may not be resource-efficient under budget constraints.
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