We categorize the ICERs in our Registry search function based on country-specific GDP per capita into 5 groups: cost-saving; less than 1x GDP; 1-3x of GDP; greater than 3x GDP; and dominated. Although we color-coded each of 5 categories to improve visibility, we do not endorse any of specific cost-effectiveness thresholds as reflective of good or reasonable value for money. We acknowledge that estimating and using cost-effectiveness thresholds are an important area of ongoing and future research.
Broadly, two concepts have emerged regarding what this threshold could represent and how it can be estimated. The first, termed a “supply-side” threshold, reflects the opportunity cost associated with devoting a health system’s resources to a particular use; hence, the forgone benefits that could have been achieved if the same resources were used for other activities. The second is a “demand-side” threshold that relates to the willingness to pay (WTP) for health improvement of a relevant group of individuals (e.g., the general public). The listed references include in-depth discussion around the cost-effectiveness threshold.
Claxton K, Martin S, Soares M, Rice N, Spackman E, Hinde S, et al. Methods for the estimation of the NICE cost effectiveness threshold. Health Technol Assessment. 2015; 19(14):503.
Neumann PJ, Cohen JT, and Weinstein, MC. Updating Cost-Effectiveness — The Curious Resilience of the $50,000-per-QALY Threshold. NEJM. 2014; 371:796-797
Ochalek J, Lomas J, Claxton K. Cost per DALY averted thresholds for low- and middle-income countries: evidence from cross country data. Centre for Health Economics Research Paper no. 122. York: CHE, University of York 2015.
Ryen L, Svensson M. The willingness to pay for a quality-adjusted life year: a review of the empirical literature DOI: 10.1002/hec.3085. Health Economics. 2014.
Sculpher M, Claxton K, Pearson SD. Developing a value framework: the need to reflect the opportunity costs of funding decisions. Value Health. 2017; 20(2):234-9.
Thokala P, Ochalek J, Leech AA, Tong T. Cost-effectiveness thresholds: the past, the present and the future. PharmacoEconomics. 2018 May 1;36(5):509-22.
Weinstein MC, Zeckhauser R. Critical ratios and efficient allocation. Journal of Public Economics. 1973; 2:147-57.
Woods B, Revill P, Sculpher M, K. C. Country-level cost-effectiveness thresholds: initial estimates and the need for further research. Value in Health. 2016; 19:929-35.
