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Cost-Effectiveness Thresholds: the Past, the Present and the Future

Author

Listed:
  • Praveen Thokala

    (University of Sheffield)

  • Jessica Ochalek

    (University of York)

  • Ashley A. Leech

    (Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center)

  • Thaison Tong

    (University of Sheffield)

Abstract

Cost-effectiveness (CE) thresholds are being discussed more frequently and there have been many new developments in this area; however, there is a lack of understanding about what thresholds mean and their implications. This paper provides an overview of the CE threshold literature. First, the meaning of a CE threshold and the key assumptions involved (perfect divisibility, marginal increments in budget, etc.) are highlighted using a hypothetical example, and the use of historic/heuristic estimates of the threshold is noted along with their limitations. Recent endeavours to estimate the empirical value of the thresholds, both from the supply side and the demand side, are then presented. The impact on CE thresholds of future directions for the field, such as thresholds across sectors and the incorporation of multiple criteria beyond quality-adjusted life-years as a measure of ‘value’, are highlighted. Finally, a number of common issues and misconceptions associated with CE thresholds are addressed.

Suggested Citation

  • Praveen Thokala & Jessica Ochalek & Ashley A. Leech & Thaison Tong, 2018. "Cost-Effectiveness Thresholds: the Past, the Present and the Future," PharmacoEconomics, Springer, vol. 36(5), pages 509-522, May.
    • Handle: RePEc:spr:pharme:v:36:y:2018:i:5:d:10.1007_s40273-017-0606-1
    DOI: 10.1007/s40273-017-0606-1
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    1. Gravelle, H.S.E. & Backhouse, M.E., 1987. "International cross-section analysis of the determination of mortality," Social Science & Medicine, Elsevier, vol. 25(5), pages 427-441, January.
    2. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884, Decembrie.
    3. Nancy Devlin;Jon Sussex, 2011. "Incorporating Multiple Criteria in HTA: Methods and Processes," Monograph 000189, Office of Health Economics.
    4. Adrian Towse;Paul Barnsley;Sarah Karlsberg-Schaffer;Jon Sussex, 2013. "Critique of CHE Research Paper 81: Methods for the Estimation of the NICE Cost Effectiveness Threshold," Occasional Paper 000106, Office of Health Economics.
    5. Gafni, Amiram & Birch, Stephen, 2006. "Incremental cost-effectiveness ratios (ICERs): The silence of the lambda," Social Science & Medicine, Elsevier, vol. 62(9), pages 2091-2100, May.
    6. Jessica Ochalek & Karl Claxton & Paul Revill & Mark Sculpher & Alexandra Rollinger, 2016. "Supporting the development of an essential health package: principles and initial assessment for Malawi," Working Papers 136cherp, Centre for Health Economics, University of York.
    7. Karl Claxton & Mark Sculpher & Stephen Palmer & Anthony J Culyer, 2015. "Causes For Concern: Is Nice Failing To Uphold Its Responsibilities To All Nhs Patients?," Health Economics, John Wiley & Sons, Ltd., vol. 24(1), pages 1-7, January.
    8. Nancy Devlin & David Parkin, 2004. "Does NICE have a cost‐effectiveness threshold and what other factors influence its decisions? A binary choice analysis," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 437-452, May.
    9. Beth Woods & Paul Revill & Mark Sculpher & Karl Claxton, 2015. "Country-level cost-effectiveness thresholds: initial estimates and the need for further research," Working Papers 109cherp, Centre for Health Economics, University of York.
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