Presentation (CTI)

OBJECTIVES: Health Technology Assessment (HTA) agencies often make decisions based on a comparison between the estimated cost-per-QALY gained from an intervention and a willingness-to-pay threshold. New therapies with a cost-per-QALY above this threshold may not be considered cost-effective, indicating that funds could be more effectively spent on other medicines or elsewhere in the health system. Recent methodological research proposes broadening the scope of economic analyses conducted by HTA agencies to include societal cost and benefits, such as improved health-related quality of life for caregivers or lost productivity. Inclusion of these wider costs and benefits tends to result in a lower cost-per-QALY, which means that opportunity costs of treatments forgone would also be higher under a broader societal perspective, implying that the willingness-to-pay threshold should be lower.
METHODS: The Institute for Clinical and Economic Review (ICER) in the US includes a modified societal perspective in their assessments of new health technologies. We reviewed ICER assessments from 2020-2025 (n=36) and compared the cost-per-QALY in the base case (healthcare perspective) analysis for each comparison (n=87) to that under the modified societal perspective.
RESULTS: We found that the cost-per-QALY in the modified societal perspective is, on average, 14.1% (range: 0.5%-97.5%) lower than in the healthcare perspective. Separately, 4 (11.4%) assessments reported at least one intervention with a higher cost-per-QALY in the modified societal perspective. Among interventions where a direct comparison between perspectives was possible and at a willingness-to-pay threshold of $100,000 per QALY, 8 (13.6%) interventions would have been considered cost-effective under the healthcare perspective, while 13 (22.0%) would have been considered cost-effective under the modified societal perspective.
CONCLUSIONS: These findings suggest that the willingness-to-pay threshold may need to be adjusted if a broader societal perspective is considered in HTA decision-making and policy recommendations.