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

50 ICER Thresholds KCE Reports 100
Key points
• In the UK, a discussion is ongoing on the use of ICER threshold values.
Currently the UK uses an explicit threshold range of £20 000 to £30 000
per QALY gained.
• Implicit threshold values based on past allocation decisions were
published in Australia (AU$69 900 / QALY gained), New Zealand
(NZ$20 000 / QALY gained) and Canada (range of acceptance: dominant
to $80 000 per QALY gained, range of rejection: $31 000 to $137 000 per
QALY gained).
• Thresholds values or ranges proposed by individuals or institutions were
found in the USA (50 000$/QALY), in the Netherlands (€80 000 per
QALY gained) and in Canada (20 000 - 100 000$/QALY).
• The lower and upper limit for the social WTP for a QALY in the US was
estimated to be 109 000$/QALY and 297 000$/QALY respectively.
• With the exception of the UK, no explicit ICER threshold value (or
range) is used in the countries examined.
• In all countries decision making is not solely based on cost-effectiveness
considerations. The technology is assessed based on the threshold range
together with other criteria. In the presence of high ICERs, those other
criteria become more important.
• In most countries it appears that interventions with a low ICER are more
likely to become accepted than interventions with a high ICER.
3.6 THE USE OF ICER THRESHOLD VALUES IN BELGIUM
Additional to the international comparison a limited field study explored the use of
cost-effectiveness evaluations in health care reimbursement decisions in Belgium. We
focused on two committees: the Drug Reimbursement Committee (DRC or
CTG/CRM) and the Technical Committee for Implants (TCI or TRI/CTI), both having an
important role in reimbursement decisions.
3.6.1 Background on DRC and TCI
The decision to reimburse pharmaceutical products and devices in Belgium is taken by
the Minister of Social Affairs after consultation with the Minister of Budget, but the
Minister is advised on these matters by the DRC and the TCI respectively. Both
committees are organised within the NIHDI but their structure, working procedures
and place in the decision making process are different.
The DRC advises the Minister of Social Affairs directly. Although the advice is not
strictly binding, the Minister can only deviate from the advice formulated by the DRC
for social or budgetary reasons. The composition of the DRC and the procedures for
formulating a reimbursement proposal for a pharmaceutical product are stipulated in
two Royal Decrees, approved on 21/12/2001. 165, 166 The DRC is composed of
representatives of sickness funds (the mutualities), universities, medical doctors and
pharmacists. Representatives of the pharmaceutical industry, the Ministry of Economic
Affairs, the Ministry of Budget, the Ministry of Social Affairs, the Ministry of Public
Health and the NIHDI can attend the meetings and participate in the discussions but
have no voting rights. The DRC has to formulate an advice within strict time limits: the
decision to reimburse a pharmaceutical product has to be taken within 180 days after
the submission of a reimbursement request file by a pharmaceutical company. The
advice of the DRC with respect to reimbursement has to reach the Minister of Social
Affairs at day 150 at the latest.