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

Laura Vallejo-Torres (), Borja García-Lorenzo, Laura Catherine Edney, Niek Stadhouders, Ijeoma Edoka, Iván Castilla-Rodríguez, Lidia García-Pérez, Renata Linertová, Cristina Valcárcel-Nazco and Jonathan Karnon
Additional contact information
Laura Vallejo-Torres: Universidad de Las Palmas de Gran Canaria
Borja García-Lorenzo: Kronikgune Institute for Health Services Research
Laura Catherine Edney: Flinders Health and Medical Research Institute, Flinders University
Niek Stadhouders: IQ Healthcare, Radboud University and Medical Center
Ijeoma Edoka: University of the Witwatersrand
Iván Castilla-Rodríguez: Universidad de La Laguna
Lidia García-Pérez: Canary Islands Health Research Institute Foundation (FIISC)
Renata Linertová: Canary Islands Health Research Institute Foundation (FIISC)
Cristina Valcárcel-Nazco: Canary Islands Health Research Institute Foundation (FIISC)
Jonathan Karnon: Flinders Health and Medical Research Institute, Flinders University

Applied Health Economics and Health Policy, 2022, vol. 20, issue 3, No 5, 337-349

Abstract: Abstract Background When healthcare budgets are exogenous, cost-effectiveness thresholds (CETs) used to inform funding decisions should represent the health opportunity cost (HOC) of such funding decisions, but HOC-based CET estimates have not been available until recently. In recent years, empirical HOC-based CETs for multiple countries have been published, but the use of these CETs in the cost-effectiveness analysis (CEA) literature has not been investigated. Analysis of the use of HOC-based CETs by researchers undertaking CEAs in countries with different decision-making contexts will provide valuable insights to further understand barriers and facilitators to the acceptance and use of HOC-based CETs. Objectives We aimed to identify the CET values used to interpret the results of CEAs published in the scientific literature before and after the publication of jurisdiction-specific empirical HOC-based CETs in four countries. Methods 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 publication of HOC estimates were recorded. We conducted logit regressions exploring factors explaining the use of HOC values in identified studies and linear models exploring the association of the reported CET value with study characteristics and results. Results 1171 studies were included in this review (870 CEAs and 301 study protocols). HOC values were cited in 28% of CEAs in Spain and in 11% of studies conducted in Australia, but they were not referred to in CEAs undertaken in the Netherlands and South Africa. Regression analyses on Spanish and Australian studies indicate that more recent studies, studies without a conflict of interest and studies estimating an incremental cost-effectiveness ratio (ICER) below the HOC value were more likely to use the HOC as a threshold reference. In addition, we found a small but significant impact indicating that for every dollar increase in the estimated ICER, the reported CET increased by US$0.015. Based on the findings of our review, we discuss the potential factors that might explain the lack of adoption of HOC-based CETs in the empirical CEA literature. Conclusions The adoption of HOC-based CETs by identified published CEAs has been uneven across the four analysed countries, most likely due to underlying differences in their decision-making processes. Our results also reinforce a previous finding indicating that CETs might be endogenously selected to fit authors’ conclusions.

Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

Downloads: (external link)
http://link.springer.com/10.1007/s40258-021-00707-8 Abstract (text/html)
Access to the full text of the articles in this series is restricted.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:spr:aphecp:v:20:y:2022:i:3:d:10.1007_s40258-021-00707-8

Ordering information: This journal article can be ordered from
http://www.springer.com/economics/journal/40258

DOI: 10.1007/s40258-021-00707-8

Access Statistics for this article

Applied Health Economics and Health Policy is currently edited by Timothy Wrightson

More articles in Applied Health Economics and Health Policy from Springer
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().