Level of ICER of Health Economic Assessment in France in 2023

OBJECTIVES: In France, the main objective of the health economic assessment is to inform the price negotiation, through the incremental cost-effectiveness ratio (ICER). The methodological validity of the ICER is appraised by the Economic & Public Health Assessment Commission (CEESP). The framework agreement signed between the pharmaceutical industry and the French Pricing Committee (CEPS) stipulates that economic evaluation can only be considered in negotiations in the absence of a major methodological reservation or major uncertainty.

METHODS: Using the Vyoo Agency database, which collects all the opinions published by the CEESP since 2014, validated health economics assessments published by CEESP between January 1^st and December 31^st, 2023, were reviewed to analyze the levels of ICERs.

RESULTS: In 2023, the CEESP validated 16 health economic assessments on 25 evaluations submitted. These opinions concern six therapeutic areas, with an average ICER of €382,627/QALY, an increase of 150% compared to 2022 (€153,392/QALY). The 2023 ICERs varied widely: 6 ICERs are below €50,000/QALY, 4 between €50,000 and €150,000/QALY, 3 between €150,000 and €250,000, 4 above €250,000/QALY and 1 treatment is dominant. For cancer treatments, ICERs varied between €23,950/QALY and €355,002/QALY. The highest ICER is for a rare disease indication with €3,965,948/QALY. The lowest ICER is for a vaccine to prevent COVID-19 infection with €18/QALY.

CONCLUSIONS: These levels of ICER are high compared to those accepted abroad, notably the UK. This is partly explained by CEESP’s methodological requirements. The CEESP’s recommendations for exploring and controlling uncertainty leads to the selection of conservative assumptions to prevent any risk of underestimating ICER. Another observation is that ICER varied widely. The inclusion of uncertainty in the main analysis generates some of this variability.