Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use

Health Economics, Policy, and Law
Anthony J Culyer

Abstract

There is misunderstanding about both the meaning and the role of cost-effectiveness thresholds in policy decision making. This article dissects the main issues by use of a bookshelf metaphor. Its main conclusions are as follows: it must be possible to compare interventions in terms of their impact on a common measure of health; mere effectiveness is not a persuasive case for inclusion in public insurance plans; public health advocates need to address issues of relative effectiveness; a 'first best' benchmark or threshold ratio of health gain to expenditure identifies the least effective intervention that should be included in a public insurance plan; the reciprocal of this ratio - the 'first best' cost-effectiveness threshold - will rise or fall as the health budget rises or falls (ceteris paribus); setting thresholds too high or too low costs lives; failure to set any cost-effectiveness threshold at all also involves avertable deaths and morbidity; the threshold cannot be set independently of the health budget; the threshold can be approached from either the demand side or the supply side - the two are equivalent only in a health-maximising equilibrium; the supply-side approach generates an estimate of a 'second best' cost-eff...Continue Reading

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Citations

Oct 14, 2016·Health Care Analysis : HCA : Journal of Health Philosophy and Policy·Lars Sandman, Erik Gustavsson
Apr 5, 2017·Applied Health Economics and Health Policy·Anna MånsdotterLars Lindholm
Feb 23, 2018·Applied Health Economics and Health Policy·Carlos Campillo-ArteroAnthony J Culyer
Feb 11, 2018·PharmacoEconomics·Praveen ThokalaThaison Tong
Feb 23, 2018·Expert Review of Pharmacoeconomics & Outcomes Research·André Soares SantosCristina Mariano Ruas
Apr 24, 2018·Expert Review of Precision Medicine and Drug Development·Sean P GavanKatherine Payne
Mar 5, 2016·Health Economics, Policy, and Law·Anthony J Culyer
Oct 27, 2018·BMJ Global Health·Y-Ling ChiPeter Smith
Sep 12, 2019·Healthcare Management Forum·Christopher McCabe, Jeff Round
Sep 19, 2019·International Journal of Technology Assessment in Health Care·Neill Booth
Dec 10, 2019·Annals of Internal Medicine·Jean-François LapriseMarc Brisson
Apr 18, 2018·BMJ Global Health·Jessica OchalekKarl Claxton
Mar 17, 2020·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Jonathan Siverskog, Martin Henriksson
Feb 6, 2020·Cadernos de saúde pública·João Paulo Vilela RodriguesLeonardo Régis Leira Pereira
Sep 5, 2017·F1000Research·Kalipso ChalkidouRyan Li
Sep 3, 2020·Cost Effectiveness and Resource Allocation : C/E·José Antonio SacristánJuan Oliva
Nov 11, 2018·PharmacoEconomics·J Jaime CaroMichael Schlander
Feb 12, 2021·Health Economics, Policy, and Law·Victoria Charlton, Albert Weale
Feb 13, 2021·Gates Open Research·Y-Ling ChiAlexander Winch
Jun 28, 2021·The International Journal of Health Planning and Management·Janvier GasanaMustafa Al-Zoughool
Jun 30, 2021·Applied Health Economics and Health Policy·Shankar PrinjaV R Muraleedharan
Dec 8, 2021·Health Policy and Planning·Oscar EspinosaMateo Ceballos
Jan 19, 2022·Applied Health Economics and Health Policy·Sándor KovácsAntal Zemplényi

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