PNS113 Cost-Effectiveness Threshold in the Czech Republic: Are ICERS Still Growing? an Updated Analysis

Abstract

In 2017, we presented a study aiming to determine the cost-effectiveness threshold (CET) according to applicable law in the Czech Republic where we analyzed all ICERs accepted for reimbursement in pharmacoeconomic evaluations made by the State Institute for Drug Control (SUKL) from 2013 to mid-2017. Based on the analysis, threshold was set to 1.2 million CZK (approximately 45,000 EUR) per QALY. The aim of this study is to provide an update of the original study and to compare ICERs from mid-2017 to 2019 (when the CET was strictly applied) with the original results. We analyzed all reimbursement proceedings between 2013 and 2019 and selected those where the pharmacoeconomic analysis fulfilled our prespecified selection criteria. Only applications for long-term reimbursement having acceptable quality were considered. The exchange rate used was 27 CZK = 1 EUR. Out of 520 (355 in 2017) proceedings in which economic evaluation was required, we identified 51 (35) cases where the medicine under review was either dominant or cost-minimizing and 88 (30) proceedings with positive ICERs. The mean positive ICER value increased from 22,712 (2013 to mid-2017) to 33,078 (mid-2017 to 2019) EUR per QALY, the median from 20,870 to 36,343 EUR per QALY. The percentage of positive ICERs above 22,500 EUR (50% of the CET) per QALY increased from 43% to 82%, of those exceeding 33,750 EUR (75% of the CET) per QALY increased from 23% to 73%. The percentage of positive ICERs above the mean increased from 43% to 73%. We reviewed pharmacoeconomic evaluations of the State Institute for Drug Control in the period of 2013-2019 and analyzed ICERs considered acceptable for long-term reimbursement. We observed an increase in mean ICER value and an in proportion of ICERs exceeding 50% and 75% of the CET value.