Factors associated with the author-reported cost-effectiveness threshold in high-income countries: systematic review and multivariable modelling

Nicolas Boespflug, Jérôme Wittwer and Antoine Bénard ()
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Nicolas Boespflug: CHU Bordeaux, Service d’information Médicale, USMR & CIC-EC 1401
Jérôme Wittwer: INSERM, Bordeaux Population Health, UMR 1219
Antoine Bénard: CHU Bordeaux, Service d’information Médicale, USMR & CIC-EC 1401

The European Journal of Health Economics, 2024, vol. 25, issue 4, No 6, 639 pages

Abstract: Abstract Objective The cost-effectiveness threshold (CET) is a key parameter to guide objective reimbursement decisions, yet very few countries have defined a reference CET, and there is no reference method for defining it. Our objective was to determine the factors explaining the author-reported CETs in the literature. Methods Our systematic review targeted original articles referenced in EMBASE and published between 2010 and 2021. Selected studies had to use Quality-Adjusted Life-Year (QALY), and being conducted in high-income countries. Our explanatory variables were: estimated cost-effectiveness ratio (ICER), region of the world, source of funding, type of intervention, disease, year of publication, justification of the author-reported Cost-Effectiveness Threshold (ar-CET), economic perspective, and declaration of interest. Multivariable linear regression models implemented on R software were used, guided by a Directed Acyclic Graph. Results Two hundred and fifty four studies were included. The mean ar-CET was €63,338/QALY (standard deviation (SD) 34,965) overall, and €37,748/QALY (SD 20,750) in studies conducted in the British Commonwealth. The ar-CET increased slightly with the ICER (+ 66€/QALY for each additional 10,000€/QALY in the ICER, 95% confidence interval (IC) [31–102], p

Keywords: Systematic review; Multivariable modelling; Cost-effectiveness threshold; Cost-effectiveness analyses; Medical devices; Drugs (search for similar items in EconPapers)
Date: 2024
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DOI: 10.1007/s10198-023-01613-7

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