PNS11 Are Estimates of the Health Opportunity Cost Being Used to Draw Conclusions on Cost-Effectiveness Analyses? a Scoping Review in Four Countries

Abstract

In many healthcare systems, reimbursement decisions are informed by cost-effectiveness analysis (CEA), but arbitrary cost-effectiveness thresholds (CET) are frequently used. CETs should be informed by the health opportunity cost (HOC) of funding decisions, and multiple countries have recently published empirical estimates following this approach. This paper aims to identify the CETs used to interpret cost-effectiveness results in four countries where empirical estimates of the HOC are readily available. We undertook a scoping review of CEAs published in Spain, Australia, The Netherlands and South Africa between 2016 (2014 in Spain) and 2020. CETs used before and after the publication of the HOC estimates were recorded. 891 CEAs were identified. In Spain, prior to 2018, 66% of CEAs used an arbitrary CET of 30,000€/QALY. This percentage dropped to 24% after the publication of the HOC estimate that ranges between 20,000€ and 25,000€, and which is now referred in 31% of CEAs published in Spain. In Australia, 58% of CEAs used the commonly cited CET of 50,000A$ before 2018. The adoption of this figure remained relatively unchanged after the publication of the HOC value, estimated at 28,000A$ in this country. This latter figure is cited in 10% of current studies. None of the identified CEAs in The Netherlands cited a HOC estimate, with over 60% of the studies applying the range of up to 80,000€ recommended by the Dutch Council for Public Health. Similarly, in South Africa, the most widely cited CET relates to 1 to 3 times the country per capita Gross Domestic Product. The adoption of evidence-based CETs by the scientific community has been uneven across the four analyzed countries. While the HOC estimate has become the most cited CET in Spain, its adoption in Australia is lower and has not been adopted in the rest of the countries.