Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
The European Journal of Health Economics
Published in: The European Journal of Health Economics 2/2019

01-03-2019 | Editorial

When is it too expensive? Cost-effectiveness thresholds and health care decision-making

Authors: Werner Brouwer, Pieter van Baal, Job van Exel, Matthijs Versteegh

Published in: The European Journal of Health Economics | Issue 2/2019

Login to get access

Excerpt

The pressure on both tax and insurance-based health care budgets has been high for many years. On the demand side, pressure is increased by an aging population and higher living standards which raise expectations regarding medical services. On the supply side, expensive new health technologies offer new treatment opportunities for patients but often at a (very) high price. Since these high prices are not necessarily a reflection of large health gains, politicians, academics and society need to answer the question when such technologies are ‘too expensive’. When is it justified to not reimburse or use such technologies, effectively limiting supply in collectively financed health care systems? Surely, such a question is not easily answered and draws in subsets of questions from different disciplines, including clinical and ethical angles. …
Footnotes
1
This does not imply that the same people are willing to pay the premium increases that logically follow from this viewpoint.
 
2
For simplicity focused on technologies with only current costs and benefits.
 
3
Note that the choice for a particular decision rule also has consequences for other methodological choices, e.g. discount rates [11, 3].
 
4
This means the proportion of health lost due to the disease the intervention is targeted at.
 
Literature
1.
Al Janabi, H., van Exel, N.J.A., Brouwer, W.B.F., Coast, J.: A framework for including health spillovers in economic evaluation. Med. Decis. Mak. 36(2), 176–186 (2016)CrossRef
2.
Attema, A.E., Krol, M., van Exel, N.J.A., Brouwer, W.B.F.: New findings from the TTO for income approach to elicit willingness-to-pay for a QALY. Eur. J. Health Econ. 19(2), 277–291 (2018)CrossRefPubMed
3.
4.
Bobinac, A., van Exel, N.J.A., Rutten, F.F.H., Brouwer, W.B.F.: Valuing QALY gains applying a societal perspective. Health Econ. 22(10), 1272–1281 (2013)CrossRefPubMed
5.
Bobinac, A., van Exel, N.J.A., Rutten, F.F.H., Brouwer, W.B.F.: Inquiry into the relationship between equity weights and the value of the QALY. Value Health 15(8), 1119–1126 (2012)CrossRefPubMed
6.
Bobinac, A., van Exel, N.J.A., Rutten, F.F.H., Brouwer, W.B.F.: Get more, pay more? An elaborate test of the validity of willingness to pay per QALY estimates. J. Health Econ. 31(1), 158–168 (2012)CrossRefPubMed
7.
Brouwer, W.B.F., van Exel, N.J.A., Baltussen, R.M.P.M., Rutten, F.F.H.: A dollar is a dollar is a dollar—or is it? Value Health 9(5), 341–347 (2006)CrossRefPubMed
8.
Brouwer, W.B.F., A.J. Culyer, van Exel, N.J.A., Rutten, F.F.H.: Welfarism vs. extra-welfarism. J. Health Econ. 27(2), 325–338 (2008)CrossRefPubMed
9.
Brouwer, W.B.F., van Exel, N.J.A., Baker, R., Donaldson, C.: The new myth: the social value of the QALY. PharmacoEconomics 26(1), 1–4 (2008)CrossRefPubMed
10.
Claxton, K., Walker, S., Palmer, S., Sculpher, M.: Appropriate perspectives for health care decisions. CHE Research Paper 54, Center for Health Economics, University of York (2010)
11.
Claxton, K., Paulden, M., Gravelle, H., Brouwer, W.B.F., Culyer, A.J.: Discounting and decision making in the economic evaluation of health care technologies. Health Econ. 20(1), 2–15 (2011)CrossRefPubMed
12.
Claxton, K., Martin, S., Soares, M., Rice, N., Spackman, E., Hinde, S., Devlin, N., Smith, P.C., Sculpher, M.: Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. Health Technol. Assess. 19(14), 1–503 (2015 Feb)CrossRefPubMedPubMedCentral
13.
Cookson, R., Mirelman, A., Asaria, M., Dawkins, B., Griffin, S.: Fairer decisions, better health for all: health equity and cost-effectiveness analysis. CHE Research Paper 135, Centre for Health Economics, University of York (2016)
14.
Edney, L.C., Afzali, H.H.A., Cheng, T.C.: J Karnon. Estimating the reference incremental cost-effectiveness ratio for the australian health system. PharmacoEconomics 36(2), 239–252 (2018)CrossRefPubMed
15.
EXPH (EXpert Panel on effective ways of investing in Health): Opinion on Innovative Payment Models for High-Cost Innovative Medicines. EXPH, Brussels (2018)
16.
Gravelle, H., Brouwer, W.B.F., Niessen, L.W., Postma, M.J., Rutten, F.F.H.: Discounting in economic evaluations: stepping forward towards optimal decision rules. Health Econ. 16(3), 307–317 (2007)CrossRefPubMed
17.
Jena, A.B., Philipson, T.J.: Endogenous cost-effectiveness analysis and health care technology adoption. J. Health Econ. 32(1), 172–180 (2013)CrossRefPubMed
18.
Mason, H., van Exel, J., Baker, R., Brouwer, W., Donaldson, C., The EuroVaQ Team. From representing views to representativeness of views: illustrating a new (Q2S) approach in the context of health care priority setting in nine European countries. Soc. Sci. Med. 166, 205–213 (2016)CrossRefPubMed
19.
Meltzer, D.: Accounting for future costs in medical cost-effectiveness analysis. J. Health Econ. 16(1), 33–64 (1997)CrossRefPubMed
20.
21.
Nord, E., Pinto, J.L., Richardson, J., Menzel, P., Ubel, P.: Incorporating societal concerns for fairness in numerical valuations of health programmes. Health Econ. 8, 25–39 (1999)CrossRefPubMed
22.
Olsen, J.A.: Priority preferences: “end of life” does not matter, but total life does. Value Health 16(6), 1063–1066 (2013)CrossRefPubMed
23.
Ottersen, T., Førde, R., Kakad, M., Kjellevold, A., Melberg, H.O., Moen, A., Ringard, Å, Norheim, O.F.: A new proposal for priority setting in Norway: open and fair. Health Policy 120(3), 246–251 (2016)CrossRefPubMed
24.
Reckers, V., van Exel, N.J.A., Brouwer, W.B.F.: Looking back and moving forward: on the application of proportional shortfall in healthcare priority setting in the Netherlands. Health Policy 122(6), 621–629 (2018)CrossRef
25.
Ryen, L., Svensson, M.: The willingness to pay for a quality adjusted life year: a review of the empirical literature. Health Econ. 24(10), 1289–1301 (2015)CrossRefPubMed
26.
Sanders, G.D., Neumann, P.J., Basu, A., Brock, D.W., Feeny, D., Krahn, M., Kuntz, K.M., Meltzer, D.O., Owens, D.K., Prosser, L.A., Salomon, J.A., Sculpher, M.J., Trikalinos, T.A., Russell, L.B., Siegel, J.E., Ganiats, T.G.: Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses. JAMA. 316(10), 1093–1103 (2016)CrossRefPubMed
27.
Tilling, C., Krol, M., Attema, A.E., Tsuchiya, A., Brazier, J., van Exel, N.J.A., Brouwer, W.B.F.: Measuring the value of life: exploring a new method for deriving the monetary value of a QALY. Eur. J. Health Econ. 17(7), 801–809 (2016)CrossRefPubMed
28.
29.
van Baal, P.H.M., Perry-Duxbury, M., Bakx, P., Versteegh, M., van Doorslaer, E.K.A., Brouwer, W.B.F.: A cost-effectiveness threshold based on the marginal returns of cardiovascular hospital spending. (submitted)
30.
van Exel, N.J.A., Baker, R., Mason, H., Donaldson, C., Brouwer, W.B.F.: Public views on principles for health care priority setting across Europe. Soc. Sci. Med. 126, 128–137 (2015)CrossRefPubMed
31.
Vellejo-Torres, L., García-Lorenzo, B., Serrano-Aguilar, P.: Estimating a cost-effectiveness threshold for the Spanish NHS. Health Econ. 27(4), 746–761 (2018)CrossRef
32.
Wailoo, A., Tsuchiya, A., McCabe, C.: Weighting must wait. PharmacoEconomics 27(12), 983–989 (2009)CrossRefPubMed
33.
van de Wetering, L.J., van Exel, N.J.A., Bobinac, A, Brouwer W.B.F.. Valuing QALYs in relation to equity considerations using a discrete choice experiment. PharmacoEconomics 2015; 33(12): 1289–1300CrossRefPubMedPubMedCentral
Metadata
Title
When is it too expensive? Cost-effectiveness thresholds and health care decision-making
Authors
Werner Brouwer
Pieter van Baal
Job van Exel
Matthijs Versteegh
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 2/2019
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-018-1000-4

Other articles of this Issue 2/2019

The European Journal of Health Economics 2/2019 Go to the issue

Original Paper

Catastrophic financial effect of replacing informal care with formal care: a study based on haematological neoplasms

Original Paper

Pricing of HPV vaccines in European tender-based settings

Original Paper

Population norms for the EQ-5D-3L: a cross-country analysis of population surveys for 20 countries

Original Paper

The association of potentially inappropriate medication use on health outcomes and hospital costs in community-dwelling older persons: a longitudinal 12-year study

Original Paper

Mapping health-related quality of life scores from FACT-G, FAACT, and FACIT-F onto preference-based EQ-5D-5L utilities in non-small cell lung cancer cachexia

Original Paper

A new method for valuing health: directly eliciting personal utility functions