International Cost-Effectiveness Thresholds and Modifiers for HTA Decision Making

The aim of this OHE report was to identify cost effectiveness thresholds (CETs) used in a selection of countries in their Health Technology Assessments (HTAs). The review found that, out of the 15 selected countries, only four specify an explicit CET in their official HTA guidelines. For the rest, an ‘implicit’ threshold – a value that is informally accepted by the decision-makers, or one based on past decisions – is used. In most of the countries reviewed, additional considerations –termed ‘modifiers’ – are incorporated when making funding and reimbursement decisions. The two main modifiers identified were severity and rarity of the disease in question. In some cases, such modifiers lead to an (upward) adjustment in the applied threshold for interventions that meet specific requirements. On the other hand, some HTA processes prefer to maintain more flexibility and apply modifiers in a ‘qualitative’ manner – that is, allowing decision committees to consider them as part of a deliberative process.

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