Session (CTI)

ISSUE: The willingness-to-pay (WTP) threshold is often key parameter in assessing whether a health intervention offers value for money, typically via an incremental cost-effectiveness ratio (ICER). Despite its theoretical appeal, WTP thresholds vary widely across health systems. Some countries link them to GDP, others adjust based on diverse modifiers, and some do not use explicit thresholds at all. This divergence has led to two models: fixed/universal thresholds, applied uniformly, and variable thresholds, which adapt to context. For example, NICE (UK) applies modifiers to QALYs which in turn impacts the ICER; ICER (US) uses multi-criteria decision analysis; ZiNL (Netherlands) adjusts based on disease burden; and ICER (US) uses multi-criteria decision analysis. While universal thresholds are often promoted in theory, they are inconsistently applied in practice. The core issue is that variable thresholds challenge the foundational assumption that a QALY is always worth the same, raising concerns not only about fairness and contextual relevance, but also about the theoretical coherence of cost-effectiveness analysis. OVERVIEW: This panel will explore whether variable thresholds better reflect diverse patient needs and system priorities. Moderator Cornelis Boersma will open with reflection (5 min) and guide discussion with provocative questions (15 min): Should HTA frameworks institutionalize variable thresholds—or abandon them altogether?; How are thresholds used to justify “value-based prices”?; What are the implications for transparency, consistency, and efficiency? Industry stakeholders may view variable thresholds as a way to enable fairer access to high-cost innovations. Academics may scrutinize their implications for methodological rigor and consistency in health economic evaluations. Policy makers must balance the flexibility of variable thresholds with the need for transparent, predictable decision-making. These perspectives will be explored by panellists Josephine Mauskopf, Jaime Caro, and Thea van Asselt, each offering a 10-minute presentation. The session concludes with audience engagement through live polls and open Q&A (10 minutes).