SynthesisApplied health economics and health policy2021
Is the Choice of Cost-Effectiveness Threshold in Cost-Utility Analysis Endogenous to the Resulting Value of Technology? A Systematic Review.
Synthesis in Applied health economics and health policy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Factors associated with the author-reported cost-effectiveness threshold in high-income countries: systematic review and multivariable modelling.The European journal of health economics : HEPAC : health economics in prevention and care · 2024Pooled it
- Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review.Frontiers in public health · 2022Pooled it
- Changing the Health Behavior of Patients With Cardiovascular Disease Through an Electronic Health Intervention in Three Different Countries: Cost-Effectiveness Study in the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) 2 Randomized Controlled Trial.Journal of medical Internet research · 2020Trial
- Quality-Adjusted Life Expectancy and Cost-Effectiveness Thresholds in Three High-Income Regions in Asia.Applied health economics and health policy · 2026Article
- Examining chronic kidney disease screening frequency among diabetics: a POMDP approach.Health care management science · 2024Article
- Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysis.JTCVS open · 2024Article
- Differential independent impact of the intraoperative use of navigation and angled endoscopes on the surgical outcome of endonasal endoscopy for pituitary tumors: a prospective study.Neurosurgical review · 2021Article
- Understanding cost-utility analysis studies in the trauma and orthopaedic surgery literature.EFORT open reviews · 2021Review
- Cost-Effectiveness Threshold for Healthcare: Justification and Quantification.Inquiry : a journal of medical care organization, provision and financingArticle
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundCost-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.
objectiveWe explored whether selection of a CUA study's CET was endogenous to estimated incremental cost-effectiveness ratios (ICERs).
methodsWe 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.
resultsAmong 317 ICERs reviewed: (A) 185 had an ICER < $50,000/QALY; (B) 53 had $50,000 ≤ ICER, < $100,000; (C) 20 had $100,000 ≤ ICER < $150,000; and (D) 59 had an ICER ≥ $150,000. Chi square testing showed a strong association (p < 0.001) between estimated ICER values and chosen CET, illustrating a lack of independence between the two. The regression analysis indicated that CETs have a baseline value of $52,000 and grow by $0.37 for each dollar increase in the estimated ICER.
conclusionsCost-effectiveness thresholds represent the hypothesis tests of typical CUAs. Our analysis highlights that most CUAs that cite high CETs also result in greater ICERs for the novel interventions that they investigate; thus, these interventions would otherwise not have been cost effective at lower CETs. Selection of a CET may come after the ICER is calculated to infer value that suits a hypothesis.
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