Context: Cost-Effectiveness Analysis (CEA) is a mandatory criterion for Heath Technology Assessment (HTA) in several countries. Despite growing economic constraint should foster the role of CEA in healthcare resource allocation, its current impact is limited by the absence of cost-effectiveness threshold/reference values in many countries which complicate their interpretation.

Objective: To propose a consistent method for estimating a Value of Statistical QALY (VSQ) gain which could be used as CEA reference values across several countries.

Methods: We adapted a method previously proposed for France[i] to 12 countries (FR, UK, ES, NL, DE, IT, SE, NOR, DK, USA, CAN, AUS) using country-specific data. VSQ was calculated from published VSL (Value of Statistical Life) estimates (based on both stated (SP)[ii] and revealed (RP)[iii] preferences), demographic data and population-based EQ-5D-3L value sets by age and gender. Local discount rates were applied.

Results: Whatever the method used to measure preferences, countries VSQs ranked similarly. The highest VSQ were find for NOR (maximum: $396,000 (SP)-$808,000 (RP)) and AUS ($289,000 (SP)-$591,000 (RP)) and the minimal one for DK ($134,000 (SP)-$274,000 (RP)). Rather small differences were observed between the main European countries.

Conclusion: Defining country-specific reference values is a key milestone for interpreting efficiency of innovations. Considering VSL estimates are available for many countries, it is possible to derive a VSQ that could be used as a cost-effectiveness threshold in most high-income countries.

[i] Tehard et al. The Value of a QALY for France: A New Approach to Propose Acceptable Reference Values. Value in health. 2020

[ii] OECD. Valuing lives saved from environmental, transport and health policies: A meta-analysis of stated preference studies. 2010

[iii] U.S. Department of Transportation. Guidance on Treatment of the Economics Value of Statistical Life in U.S. Department of Transportation Analyses. 2018.