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Extra resources for Ensuring Value for Money in Health Care: The Role of Health Technology Assessment in the European Union (Who Regional Office for Europe)
It can be problematic to interpret the results of CE analyses and, therefore, difficult to decide whether to adopt a particular treatment. As a result, a CE or willingness-to-pay threshold often serves as a general decision rule for ascertaining value for money. An intervention’s CE ratio often is compared to the threshold in order to recommend inclusion or exclusion in the benefits package. g. disease burden, health equity) are a consideration. Few countries employ a formal or fixed threshold, or at least do not make this explicit.
As a general rule, institutions require the discount rate to be included in the sensitivity analysis in order to determine the effects on outcomes. 15 This compares the incremental cost of an intervention with the corresponding incremental health improvement. The health improvements typically are measured in QALYs gained, so the CE ratio usually is expressed as a cost per QALY gained. Treatments with a relatively lower CE ratio are considered most cost-effective. Essentially, CE ratios indicate which health technologies will provide health improvements most efficiently (Garber, 2000).
G. pharmacological characteristics, ease of use) • affordability. Rawlins and Culyer (2004) report that NICE usually requires additional justification for CE ratios over £25 000/QALY such as the degree of uncertainty; wider societal costs and benefits; and the particular features of the condition and population using the technology. The Netherlands has an ongoing discussion about adopting a decision framework based on both efficiency and equity criteria. Different thresholds would apply according to disease burden (essentially necessity) with higher CE ratios allowed for the most severe diseases.