Is the Choice of Cost-Effectiveness Threshold in Cost-Utility Analysis Endogenous to the Resulting Value of Technology? A Systematic Review
William V. Padula (),
Hui-Han Chen and
Charles E. Phelps
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William V. Padula: University of Southern California
Hui-Han Chen: University of North Carolina
Charles E. Phelps: University of Rochester
Applied Health Economics and Health Policy, 2021, vol. 19, issue 2, No 3, 155-162
Abstract Background Cost-utility analysis (CUA) is widely used for health technology assessment; however, concerns exist that cost-utility analysts may suggest higher cost-effectiveness thresholds (CETs) to compensate for technologies of relatively lower value. Objective We explored whether selection of a CUA study’s CET was endogenous to estimated incremental cost-effectiveness ratios (ICERs). Methods We systematically reviewed the US cost-effectiveness literature between 2000 and 2017 where studies with explicit CET and ICERs were included. We classified the ratio of studies hypothesized to analyze cost-effective technologies at low CETs (i.e., less than $100,000/quality-adjusted life-year [QALY]) vs higher CETs (i.e., $100,000–$150,000/QALY) relative to their ICER, using a Chi square test to examine whether technologies that were cost effective at high CETs would still be cost effective at lower thresholds. We also performed fixed-effects linear regression exploring the associations between ICERs and reported CETs over time. Results Among 317 ICERs reviewed: (A) 185 had an ICER
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