PHP81 - Estimation of Supply Side Cost Effectiveness Threshold in Ukraine: Perspective Use in Health Care Decision-Making

Abstract

Estimate supply side cost effectiveness threshold (CET) and develop recommendations to guide reimbursement decision-making in Ukraine. Literature review was conducted to identify methods and data sources required to estimate the supply side CET in Ukraine. Methods identified: empirical estimation of CET and evaluation of the effect of health care expenditure on mortality outcomes using cross country level data; analysis of the previous reimbursement decisions; estimates of CET for lower and middle income countries by Ochalek et al. (2015); revised WHO recommendation on setting the CET. The following data sources were used to estimate Ukraine specific CET: mortality rates provided by World Bank, empirical analysis of UK CET by Claxton et al. (2013), expected GDP per capita of USD 2,700 in year 2018. The estimates of Ukraine CET were benchmarked against CET estimates for Ukraine neighbouring countries and countries with similar level of economic development. The cost per QALY CET was estimated at 19%-66% of GDP or USD 513-1,782. The updated WHO recommendation on setting CET indicated that local data needs to be taken into account and that the 1-3 GDP per capita threshold should not be used as a rule of thumb, as this can potentially lead to a wrong reimbursement decision and forgone health. The local analysis of effects of health care expenditures on health gains can't be performed due to lack of detailed country level data in Ukraine. As of 2018 the results reported by Ochalek et al. (2015) is a sole source of CET data for Ukraine. Multi-criteria decision analysis frameworks have also been suggested by WHO. Ukraine should consider establishing a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in and is consistent, fair and transparent.