VP77 Extrapolating ICERs At Different Discount Rates

Abstract

IntroductionApplicability of incremental cost-effectiveness ratios from another jurisdiction is often affected by a different local discount rate, creating uncertainty about the ICER using the local discount rate. The ICER is sometimes reported at additional discount rates in the sensitivity analysis. We aimed to investigate the extent to which an ICER can be predicted at a given non-differential discount rate if estimates are available for at least two discount rates.MethodsWe used six previously published economic models representing analyses with a range of time horizons and ICERs calculated at discount rates from 1% to 8%. A simulation exercise was applied whereby the ICER at a discount rate selected from the range 2% to 5% was calculated based on ICERs provided at two or three randomly selected discount rates. With two discount rates a linear model was used to predict the ICER at the selected rate. For three discount rates an exponential model was used. Error between the predicted and actual ICER was calculated as the absolute difference divided by the actual ICER.ResultsFor four of the models, ICERs could be well predicted by a linear model (i.e., with two points), with average errors of less than 5%. For the final two models the error was substantial with a linear model but substantially improved to under 15% with an exponential model (i.e., with three data points). The two models with a poor fit to a linear model assessed childhood vaccination programmes over a lifetime horizon.ConclusionsFor studies with a relatively short time-horizon, or where the majority of costs and benefits accrue in the short-term, a simple linear extrapolation can facilitate calculation of the ICER at a discount rate other than those reported. With longer time horizons, a third data point facilitates more reliably extrapolation of ICERs at desired discount rates.