Valeurs seuils pour le rapport coût-efficacité en soins de santé - KCE

KCE reports 100 ICER Thresholds 1
Scientific summary
Table of contents
GLOSSARY ................................................................................................................................. 3
ABBREVIATIONS ...................................................................................................................... 5
1 GENERAL INTRODUCTION ........................................................................................ 6
1.1 BACKGROUND........................................................................................................................................... 6
1.2 PROBLEM STATEMENT............................................................................................................................. 6
1.3 SCOPE OF THIS REPORT.......................................................................................................................... 7
1.4 OBJECTIVES................................................................................................................................................... 7
1.5 METHODOLOGY........................................................................................................................................ 7
1.6 STRUCTURE OF THIS REPORT .............................................................................................................. 8
2 ICERS AND ICER THRESHOLD VALUES................................................................... 9
2.1 GENERAL PRINCIPLES OF ECONOMIC EVALUATION IN HEALTH CARE ............................. 9
2.2 THE INCREMENTAL COST-EFFECTIVENESS RATIO (ICER)........................................................10
2.3 THE COST-EFFECTIVENESS PLANE ....................................................................................................11
2.4 METHODOLOGICAL ISSUES OF THE ICER......................................................................................12
2.4.1 Comparability of ICERs for different interventions................................................................12
2.4.2 Uncertainty around the ICER......................................................................................................13
2.4.3 When do we incur costs and when do we reap the benefits? .............................................14
2.5 THE ICER THRESHOLD VALUE IN A FIXED BUDGET SETTING...............................................15
2.5.1 Basic assumptions...........................................................................................................................15
2.5.2 Identifying the ICER threshold value..........................................................................................16
2.5.3 Characteristics of the ICER threshold value in a fixed budget setting................................17
2.5.4 Interpretation of the ICER threshold value in a fixed budget setting .................................17
2.6 METHODOLOGICAL ISSUES OF THE ICER THRESHOLD VALUE ............................................18
2.6.1 Uncertainty around the ICER and the ICER threshold value ...............................................18
2.6.2 Comparison with an appropriate comparator.........................................................................19
2.6.3 Measurement units in nominator and denominator ...............................................................20
2.7 HOW WELL ARE THE THEORETICAL ASSUMPTIONS FOR THE ICER THRESHOLD
VALUE FULFILLED IN REAL LIFE?.........................................................................................................20
2.7.1 Fixed budget....................................................................................................................................21
2.7.2 Complete information on costs and effects of all health interventions..............................23
2.7.3 Perfect divisibility and constant returns to scale.....................................................................24
2.7.4 Health programmes are independent from one another ......................................................25
2.7.5 Health maximisation as the sole goal of health policy makers .............................................25
2.7.6 Additional caveats ..........................................................................................................................27
2.8 ALTERNATIVES TO ICERS AND ICER THRESHOLD VALUES ....................................................28
2.8.1 The ICER threshold value as a reflection of societal willingness to pay.............................29
2.8.2 Comparison with past decisions .................................................................................................30
2.8.3 Weighing the ICER against other decision criteria in the decision making process........31
2.8.4 The average GDP per capita as a threshold value for the average cost-effectiveness ratio
32
2.8.5 The opportunity costs approach.................................................................................................33
2.8.6 Cost-consequences analysis.........................................................................................................34
3 THE ROLE OF ECONOMIC EVALUATIONS IN HEALTH CARE DECISION
MAKING..........................................................................................................................36
3.1 DECISION MAKING PROCESSES .........................................................................................................36
3.2 INFORMED POLICY DECISION MAKING.........................................................................................37