LARGELY IGNORED- THE IMPACT OF THE THRESHOLD VALUE FOR A QALY ON THE IMPORTANCE OF A TRANSFERABILITY FACTOR
Author(s)
Vemer P, Rutten-van Molken MErasmus MC, Rotterdam, Netherlands
Presentation Documents
Recently, several checklists have been developed which systematically check the transferability of cost-effectiveness (CE) studies between jurisdictions. Some even provide a quantitative score of the degree of transferability. The interpretation of such a score is, however, difficult. In addition, the threshold value for a QALY is a factor that has been given little consideration in these checklists. The importance of a factor as a cause of between-country differences in CE depends on this threshold: factors that explain most of the differences in CE at a low threshold need not be the same factors at a higher threshold. OBJECTIVES: To compare the impact of nine potential causes of variation in CE of smoking cessation support (SCS), at different thresholds for the willingness-to-pay per QALY (WTP). METHODS: A model-based study compared the cost-effectiveness of SCS between six Western-European countries. For several values of WTP, we investigated the impact of between-country differences in nine factors on the incremental net monetary benefit (INMB). The factors were demography, smoking prevalence, mortality, epidemiology and costs of smoking-related diseases, resource use and unit costs of SCS, utility weights and discount rates. RESULTS: Currently, SCS is not reimbursed in the Netherlands, corresponding to a WTP of € 0. With a WTP below €1000, the factors most responsible for between‑country differences in INMB are resource use and unit costs of SCS and the costs of smoking-related diseases. Utility values have little impact. At a threshold above €10,000, between-country differences are primarily due to different discount rates, utility weights and epidemiology of smoking-related diseases (incidence and mortality). Costs of smoking-related diseases have little impact above €20,000. At all thresholds, demography has little impact. CONCLUSIONS: When judging the transferability of a CE study to another jurisdiction, we should consider the between-country differences in threshold values per QALY.
Conference/Value in Health Info
2009-10, ISPOR Europe 2009, Paris, France
Value in Health, Vol. 12, No. 7 (October 2009)
Code
PMC4
Topic
Clinical Outcomes, Economic Evaluation
Topic Subcategory
Clinical Outcomes Assessment, Cost/Cost of Illness/Resource Use Studies
Disease
Multiple Diseases, Respiratory-Related Disorders