OBJECTIVES : Cost-effectiveness thresholds (CETs) play an important role in positioning health technology assessment (HTA) in the reimbursement decisions of health technologies. This is particularly important in lower income countries with highly limited healthcare resources. Our goal is to provide scientifically solid recommendations for a new cost-effectiveness threshold to the Hungarian healthcare system.

METHODS : The Threshold Working Group of ISPOR Hungary Chapter performed a targeted literature review on explicit CETs in multiple countries. Revealed evidence on CETs and its stratification served as a basis for our recommendation, which was discussed at the workshop of the ISPOR Hungary Chapter and deliberated at an expert committee meeting with representatives from the national HTA and healthcare payer bodies, and academic HTA centers.

RESULTS : The current Hungarian CET is the highest among European countries relative to GDP per capita, and higher in nominal value than the threshold applied by neighboring countries with similar economic status or even the threshold applied by NICE and SMC in the United Kingdom. As opposed to the single Hungarian threshold, all other European countries apply multiple thresholds to prioritize technologies in rare or severe diseases or end-of-life therapies. The Working Group recommends that Hungary should apply multiple CETs in the range of 1.5 to 3 times GDP per capita with stratification according to the relative QALY gain of the new technology. In addition, multiple CETs in the range of 3 to 5 times GDP per capita with stratification according to the absolute QALY gain is recommended for technologies in rare diseases.

CONCLUSIONS : CETs should reflect the opportunity cost of resource allocation decisions, the country’s economic performance and should be in line with societal preferences. Our recommendation may increase the efficiency of healthcare resource allocation in Hungary by strengthening the role of HTA in the reimbursement decisions of new technologies.