Cost-effectiveness thresholds: methods for setting and examples from around the world

ABSTRACT

Introduction: Cost-effectiveness thresholds (CETs) are used to judge if an intervention represents sufficient value for money to merit adoption in healthcare systems. The study was motivated by the Brazilian context of HTA, where meetings are being conducted to decide on the definition of a threshold.

Areas covered: An electronic search was conducted on Medline (via PubMed), Lilacs (via BVS) and ScienceDirect followed by a complementary search of references of included studies, Google Scholar and conference abstracts. Cost-effectiveness thresholds are usually calculated through three different approaches: the willingness-to-pay, representative of welfare economics; the precedent method, based on the value of an already funded technology; and the opportunity cost method, which links the threshold to the volume of health displaced. An explicit threshold has never been formally adopted in most places. Some countries have defined thresholds, with some flexibility to consider other factors. An implicit threshold could be determined by research of funded cases.

Expert commentary: CETs have had an important role as a ‘bridging concept’ between the world of academic research and the ‘real world’ of healthcare prioritization. The definition of a cost-effectiveness threshold is paramount for the construction of a transparent and efficient Health Technology Assessment system.

KEYWORDS:

• Cost-benefit analysis
• cost-effectiveness analysis
• economics, medical
• economics, pharmaceutical
• expert testimony
• review
• technology assessment, biomedical

Declaration of interest

A Santos received financial support from Fundação de Amparo a Pesquisa de Minas Gerais. AA Guerra-Junior received a Newton Advanced Fellowship grant. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the Brazilian research promoting organizations Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) under Grant [456373/2014-4]; Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) under Grant [03616-13]; and SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES). No pharmaceutical industries contributed with resources for this paper.