Abstract
The use of cost–effectiveness as final criterion in the reimbursement process for listing of new pharmaceuticals can be questioned from a scientific and policy point of view. There is a lack of consensus on main methodological issues and consequently we may question the appropriateness of the use of cost–effectiveness data in health care decision-making. Another concern is the appropriateness of the selection and use of an incremental cost–effectiveness threshold (Cost/QALY). In this review, we focus mainly on only some key methodological concerns relating to discounting, the utility concept, cost assessment, and modeling methodologies. Finally we will consider the relevance of some other important decision criteria, like social values and equity.
Highlights
Escalating costs have become a major concern for healthcare professionals, decision-makers, and the public, prompting the implementation of new cost containment measures over the last decade, especially for new pharmaceuticals
The health care community “cannot seem to get out of the starting blocks when it comes to considering objectives outside of cost–effectiveness.”
Separate budgets may be required for life-saving products, which are not cost–effective
Summary
Escalating costs have become a major concern for healthcare professionals, decision-makers, and the public, prompting the implementation of new cost containment measures over the last decade, especially for new pharmaceuticals. The health care community “cannot seem to get out of the starting blocks when it comes to considering objectives outside of cost–effectiveness.” For example, separate budgets may be required for life-saving products, which are not cost–effective.
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