Presentation (CTI)

OBJECTIVES: Health technology assessment (HTA) agencies vary significantly worldwide in how they determine cost-effectiveness (CE) for the reimbursement of interventions using incremental cost effectiveness ratios and willingness-to-pay thresholds. Understanding how different regions integrate thresholds, macroeconomic indicators, and social values into healthcare decision-making is critical for global market access. This study maps the diverse landscape of CE thresholds and rationales across 20 heterogeneous countries spanning six global regions.
METHODS: A scoping review framework was conducted in 20 HTA agencies across Europe (n=10), Asia-Pacific (n=5), South America (n=2), North America (n=1), Middle East (n=1), and Africa (n=1) up to June 2026. Data concerning institutional CE threshold types (explicit versus implied), legal threshold updates, reliance on macroeconomic indicators, and the application of severity modifiers or rarity multipliers were captured and analysed.
RESULTS: Of the 20 countries evaluated, 11 (55%) maintain explicit thresholds, 5 utilise implicit thresholds, and 4 operate without a formal threshold or reject QALY-based criteria entirely. 3 have formally updated and increased their numeric or legal thresholds. Macroeconomic tracking is adopted by 5 countries, driven by Gross Domestic Product. Further, 9 countries actively integrate social value judgements into reimbursement decisions via explicit severity modifiers or rarity multipliers, allowing legal thresholds to dynamically scale up for severe, orphan conditions or significant health gains. Notably, 6 countries simultaneously deploy both explicit thresholds and severity or rarity modifiers.
CONCLUSIONS: Although heterogeneous, the global HTA landscape demonstrates a preference for dynamic, value-based frameworks that adjust thresholds based on social value modifiers such as disease severity and rarity, or actively employ macroeconomic tracking, over fixed reimbursement caps across all indications. Also, legal adjustments of explicit thresholds were driven by stakeholder pressure and patient access to innovative medicines. These shifts highlight a future HTA trend toward balancing resource constraints with societal equity.