Framework for Cost-Effectiveness Threshold Values: The Case of Oman

OBJECTIVES: The conclusion about the economic value of health technologies cannot be drawn without the comparing incremental cost-effectiveness ratios to threshold values. As part of developing methodological guidelines for health technology assessment in the Sultanate of Oman, our objective was to determine appropriate cost-effectiveness threshold (CET) value framework based on expert consultation with representatives of key stakeholders.

METHODS: Key findings of a recently conducted systematic review were discussed at a multistakeholder workshop in March 2024. Workshop participants were asked to vote through an anonymous online survey on how to design the CET framework and what should be the actual values.

RESULTS: 21 survey respondents agreed that multiple threshold values based on cost per QALYs should be introduced in Oman, which are linked to the economic status of the country. The baseline CET should be equal with the 1x GDP per capita. Participants recommended 3 different threshold multipliers to reflect health policy priorities. Continuous multiplicator between 1 and 3 based on the incremental relative QALY gain (IRQG) was selected to positively discriminate new health technologies with significant health gain. Fixed multiplicator of 2 was selected for both orphan drugs and cancer medicines.

CONCLUSIONS: The willingness to pay for a QALY gain in Oman cannot exceed 1x GDP per capita for new health technologies with minor health in common diseases. However, based on health policy priorities the maximum threshold value can be increased upto 12x GDP per capita for a QALY gain in case of curative medicines for rare cancer diseases. It is highly recommended that CET values are revised based on initial experiences in maximum 3 years.