OBJECTIVES: The results of cost-effectiveness analyses (CEAs) are often generalised between countries. However, the accuracy of their results is remaining uncertain when these countries have important differences in their economies. The aim of this study is to investigate compatibility between the results of a previously published CEA in Iran as a middle-income country (MIC) with the results of transferred studies from high-income countries (HICs).

METHODS: We systematically searched and selected model-based CEAs in HICs which were designed in the same method with an original country-specific CEA in Iran. The transferability of these studies to Iran was assessed using van Haalen method. Two methods were used to estimate incremental costs. In the first method, costs were corrected using consumer price indices and transferred to the Iran setting using purchasing power parities (PPP). The second method involved estimating initial trastuzumab costs and combining it with the incremental downstream costs. For both methods, incremental effects were adjusted estimating Quality-adjusted life-years (QALYs) based on differences in life expectancy from age at treatment onset. Cost-effectiveness results were compared with the results of an Iran-based CEA.

RESULTS: Five of the nine CEAs identified passed van Haalen method. The transferred incremental cost-effectiveness ratios (ICERs) of the first method (€43,390/QALY(USA); €11,077/QALY(UK); €7,926/QALY(USA); €5,261/QALY(Portugal); €4,013/QALY(Belgium)) did not match the ICER of the Iranian CEA (€16,773/QALY). However, we could estimate a closer ICER (€16,473/QALY vs €16,773/QALY) with the second method.

CONCLUSIONS: This study introduces a method to facilitate transferring the results of CEAs from HICs to MICs which is more efficient than the current methods. When there is a major economic gap between countries, costs of expensive drugs should not be transferred using relative PPPs. The second method may be a solution to estimate a rough ICER in MICs while a country-specific CEA is recommended for a reimbursement decision-making.