OBJECTIVES: The aim was to verify in which Central and Eastern European (CEE) countries the incremental cost-effectiveness ratio (ICER) threshold is used to support reimbursement decisions. It was also investigated how ICER threshold are in relation to the gross domestic product (GDP) per capita in CEE countries.

METHODS:: In-depth interviews among HTA experts were conducted. The study included 19 CEE countries: Albania, Bosnia and Hercegovina, Bulgaria, Croatia, Czech Republic, Estonia, Greece, Hungary, Latvia, Lithuania, Moldova, Montenegro, North Macedonia, Poland, Romania, Serbia, Slovakia, Slovenia, and Ukraine. For each mentioned country, as available, ICER threshold - was presented in two forms: as a value in EUR and converted into GDP fraction per capita.

RESULTS: The majority of CEE countries use ICER threshold to support decision-making. In some countries, ICER threshold determines whether the gain from new technology is worth paying for, while in other countries this indicator only plays a supporting role in reimbursement decisions. ICER thresholds in relation to GDP per capita vary meaningfully, also between countries with similar cultural environment and economic status.

CONCLUSIONS: Among the countries that use ICER threshold, its values and significance in the reimbursement decision-making process vary. ICER seems to be country-specific contingent on aspects not strictly related to gross domestic product per capita.