OBJECTIVES:

HTA guidance has been mostly driven by situations where innovative and usually more expensive technologies are compared to the prevailing standards of care. Cheaper and not unacceptably less efficacious interventions have usually received scarce attention, although strategies with minimal individual efficacy losses might produce collective health gains when savings are redistributed. This systematic review of health economic evaluations identifies interventions that are both cost and outcome reducing to procure a list of candidate decrementally cost-effective technologies.

METHODS:

English language searches were performed in PubMed, EMBASE and ClinicalTrials.gov covering 2005 to 2019. Full economic evaluations reporting in English decrementally cost-effective health technologies based on RCT data, modelling or mixed methods.

RESULTS:

After filtering 3,689 studies found through the systematic database search, 86 decrementally cost-effective health technologies (HTs) were identified. Over a third were services (n=32) and nearly a quarter were drugs (n=21). For over half of the studies (n=48) health outcomes were measured in QALYs and the incremental cost-utility ratios varied from €140 to €4.9 million saved per QALY lost. Less than a quarter of the studies were carried out from the societal perspective and time horizons varied from four days follow-up to lifetime extrapolations.

CONCLUSIONS:

Our results show a growth in recent years in the number of economic publications demonstrating decrementally cost-effective HTs. Economic tools are needed to facilitate the adoption of such HTs by policy-makers at national level to maximise health outcomes at the population level.