ArticlePharmacoEconomics2016
The Irish Cost-Effectiveness Threshold: Does it Support Rational Rationing or Might it Lead to Unintended Harm to Ireland's Health System?
Article in PharmacoEconomics, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Use of Productivity Loss/Gain in Cost-Effectiveness Analyses for Drugs: A Systematic Review.PharmacoEconomics · 2021Pooled it
- Cost-effectiveness of a mobile health-supported lifestyle intervention for pregnant women with an elevated body mass index.International journal of obesity (2005) · 2020Trial
- Bevacizumab for Metastatic Colorectal Cancer with Chromosomal Instability: Cost-Effectiveness Analysis for a Novel Precision Treatment Approach in Germany, Ireland and Spain.PharmacoEconomics · 2026Article
- Establishing cost-effectiveness threshold in China: a community survey of willingness to pay for a healthylife year.BMJ global health · 2024Article
- Cost-effectiveness evidence on approved cancer drugs in Ireland: the limits of data availability and implications for public accountability.The European journal of health economics : HEPAC : health economics in prevention and care · 2022Article
- An Economic Evaluation of 'Sheds for Life': A Community-Based Men's Health Initiative for Men's Sheds in Ireland.International journal of environmental research and public health · 2022Article
- Understanding cost-utility analysis studies in the trauma and orthopaedic surgery literature.EFORT open reviews · 2021Review
- The marginal benefits of healthcare spending in the Netherlands: Estimating cost-effectiveness thresholds using a translog production function.Health economics · 2019Article
- Beneluxa: What are the Prospects for Collective Bargaining on Pharmaceutical Prices Given Diverse Health Technology Assessment Processes?PharmacoEconomics · 2019Article
- Article
- Personalising adherence-enhancing interventions using a smart inhaler in patients with COPD: an exploratory cost-effectiveness analysis.NPJ primary care respiratory medicine · 2018Article
- Estimating the Reference Incremental Cost-Effectiveness Ratio for the Australian Health System.PharmacoEconomics · 2018Article
- Extended Experience of Lower Dose Sapropterin in Irish Adults with Mild Phenylketonuria.JIMD reports · 2018Article
- Availability and Pricing New Medicines in Ireland: Reflections and Reform.PharmacoEconomics · 2017Article
- The Pharmacoeconomic Evaluation Process in Ireland.PharmacoEconomics · 2016Article
- Application of the Price-Volume Approach in Cases of Innovative Drugs Where Value-Based Pricing is Inadequate: Description of Real Experiences in Italy.Clinical drug investigation · 2016Article
- Colorectal Cancer Screening within Colonoscopy Capacity Constraints: Can FIT-Based Programs Save More Lives by Trading off More Sensitive Test Cutoffs against Longer Screening Intervals?MDM policy & practiceArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Ireland is one of the few countries worldwide to have an explicit cost-effectiveness threshold. In 2012, an agreement between government and the pharmaceutical industry that provided substantial savings on existing medications set the threshold at €45,000/quality-adjusted life-year (QALY). This replaced a previously unofficial threshold of €20,000/QALY. According to the agreement, drugs within the threshold will be granted reimbursement, whereas those exceeding it may still be approved following further negotiation. A number of drugs far exceeding the threshold have been approved recently. The agreement only applies to pharmaceuticals. There are four reasons for concern regarding Ireland's threshold. The absence of an explicit threshold for non-drug interventions leaves it unclear if there is parity in willingness to pay across all interventions. As the threshold resembles a price floor rather than a ceiling, in principle it only offers a weak barrier to cost-ineffective interventions. It has no empirical basis. Finally, it is probably too high given recent estimates of a threshold for the UK based on the cost effectiveness of services forgone of approximately £13,000/QALY. An excessive threshold risks causing the Irish health system unintended harm. The lack of an empirically informed threshold means the policy recommendations of cost-effectiveness analysis cannot be considered as fully evidence- based rational rationing. Policy makers should consider these issues and recent Irish legislation that defined cost effectiveness in terms of the opportunity cost of services forgone when choosing what threshold to apply once the current industry agreement expires at the end of 2015
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.