OBJECTIVES : Reviews by the Institute for Clinical and Economic Review (ICER) have recently gained prominence. One controversial aspect of ICER’s analyses is their “budget impact threshold” which is based on the assumption that, as a country grows wealthier, it prefers to continue spending approximately the same proportion of its wealth on healthcare versus other goods and services (i.e., the marginal utilities of additional healthcare and additional non-healthcare goods and services are approximately equal). ICER quantifies this by stipulating that growth in healthcare spending should not exceed national GDP growth +1%. We sought to determine if this assumption reflects how high-income Western countries have historically allocated resources.

METHODS : The most recent World Bank data for GDP growth, GDP, and total healthcare spend as a percentage of GDP were downloaded for the years 1995 through 2014. Country-level annual percentage changes in total healthcare spend were calculated. Countries were included in the analysis if they were classified as “high income” by the World Bank, were located in Europe, North America, or Australia, and had no missing data. To determine whether ICER’s threshold reflected historical allocations, we assessed the differences between annual growth in healthcare spend and annual GDP growth for each country over the data period.

RESULTS : CONCLUSIONS : ICER’s budget impact threshold accurately describes how high-income Western countries have allocated increased wealth only a minority of the time. Thus, ICER’s budget impact threshold may not accurately reflect high-income Western countries’ revealed preferences.