Average CET Limit: Is It Possible to Introduce a Single CET for the Whole EEA?

OBJECTIVES: The Cost-Effectiveness Threshold (CET) is used as one of the last barriers to introducing new health interventions. A common CET could stimulate a debate on a common pricing policy for medicines within the European Economic Area (EEA). This work aimed to determine the average value of CET in the EEA and to propose a method of standardization of use in the EEA from the obtained values.

METHODS: Keywords "cost-effectiveness threshold/willingness-to-pay in (country name)" were used to search for publications in the Web of Science database and on Google. For each country, the most up-to-date (2011-2022) publications were searched, which contained specifically identified CETs or approved guidelines for that country. For comparison, CET for each country was recalculated according to the WHO recommendation of 3x GDP per capita in 2020.

RESULTS: 16 official and eight unofficial CETs were found: the lowest lower limit was in Sweden (€ 9,523). Denmark had the highest maximum CET (€ 171,861 - 3x GDP) - not officially approved. The average lower bound CET in the EEA was € 26,272, and the average upper bound CET was € 56,873. In the EEA, Bulgaria has the lowest GDP per capita (€ 9,456) and Liechtenstein the highest (€ 164,941). The average GDP per capita in the EEA was € 39,071.

CONCLUSIONS: Using CET as recommended by the WHO would raise the threshold in most countries, especially countries with high GDP per capita. Due to significant economic differences between EEA countries, it is impossible to determine a single CET for all countries. A common CET could be designated for 5 groups of countries broken down by GDP per capita (0-19,999; 20,000-29,999; 30,000-49,999; 50,000-79,999; 80,000 and more). The average value of GDP in the groups would be € 14,982; € 24,381; € 44,563; € 58 683, and € 118 080.