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

KCE reports 100 ICER Thresholds 59
• Second, political decision making structures and cultures diverge. The role
and place of stakeholder deliberation processes and the importance given
to technocratic analysis is different between countries. Moreover, the
societal context (e.g. values of the welfare state, political preferences, …)
potentially impacts on the criteria considered and on health care decision
making processes and outcomes. The differences between the systems
and the place of economic evaluations in decision making processes within
these systems merit further exploration, in order to open the “black box”
of decision making on health technologies.
A first practical step should aim at a better understanding of the decision making criteria
on health technologies. It is an ethical principle that these criteria should be transparent
and debatable within a democratic welfare state. The criteria used when taking
decisions about a technology have to be identified in a scientific manner. This requires
multidisciplinary scientific research (economics, medical science, ethics, and social
science). A clearer definition of the criteria policy makers wish to take into account
when taking decisions on health interventions would allow the HTA community to
increase the value of its assessments for policy makers.
Key points
• There is a consensus that economic efficiency should be one of the
decision making criteria. There are different ways to introduce efficiency
considerations in the decision making process.
• Using ICERs in combination with an ICER threshold value is one
possibility.
• Methodological variability in economic evaluations reduces the value of
ICERs for assessing interventions’ cost-effectiveness. Compliance with the
guidelines for economic evaluations and control of the economic
evaluations is needed if ICERs are to inform health care policy makers.
• The ICER threshold value is generally perceived as a fixed value against
which the ICERs of other interventions can be compared to decide
whether the new intervention is cost-effective. In real life, however, the
ICER threshold value can never be a fixed value over a long period of
time.
• Alternative approaches are the in-between comparison of ICERs without
reference to an ICER threshold value, the opportunity cost approach and
the cost-consequences approach. Combinations of different alternatives
are probably the most valuable.
• Although the weight of economic considerations might differ between
decisions, ignoring economic efficiency in health care decision making is
unethical.
• Besides economic and clinical research based arguments, social justice
considerations remain a core element in the decision making process.
The question on the allocation of limited resources to obtain optimal
outcomes is therefore not a technical “neutral” issue but also an issue of
societal values.
• More research is needed on the applicability of theoretical foundations
for CEA in different health care systems and on the place of CEA in
different political decision making structures and cultures.
• Research is also needed on the decision criteria deemed relevant in the
Belgian context.