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The cost-per-QALY threshold in England: Identifying structural uncertainty in the estimates
Bernarda Zamora1, Adrian Towse2
1Department of Surgery and Cancer, Imperial College, London, United Kingdom.
Frontiers in Health Services
|March 17, 2023
Summary
Estimating opportunity cost for health policy requires understanding uncertainty. Research suggests current thresholds may need revision, highlighting the need for further evidence generation to inform healthcare spending decisions.
Area of Science:
- Health Economics
- Health Policy Analysis
- Decision Science
Background:
- Estimates of opportunity cost are increasingly used to set cost-per-quality-adjusted life year (QALY) thresholds for healthcare policy.
- Understanding the uncertainty surrounding these estimates is crucial for informing policy decisions and determining if current benchmarks require revision.
Purpose of the Study:
- To analyze uncertainty in opportunity cost estimation methods used in England's NHS.
- To assess the impact of structural uncertainty on cost-per-QALY thresholds.
- To identify areas for further research to reduce decision uncertainty.
Main Methods:
- Analysis of three papers estimating opportunity cost using NHS England data.
- Cross-sectional regression analyses to estimate the impact of expenditure on mortality.
- Translation of mortality elasticities into cost-per-QALY thresholds, exploring structural uncertainty.
Main Results:
- Plausible structural assumptions place estimated thresholds within the NICE range (£20,000-£30,000 per QALY).
- Structural uncertainty in translating elasticities to thresholds was explored.
- Heterogeneity as a source of uncertainty was also discussed.
Conclusions:
- Further research is needed to reduce decision uncertainty around opportunity cost thresholds.
- Prioritizing research on disease burden and quality of life impact of health expenditure is recommended for policy makers.
- Improved evidence generation is essential for refining healthcare resource allocation.
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