Systematic overview of cost-effectiveness thresholds in ten countries across four continents.
OBJECTIVE
To provide an overview of thresholds for incremental cost-effectiveness ratios (ICERs) representing willingness-to-pay (WTP) across multiple countries and insights into exemptions pertaining to the ICER (e.g., cancer). To compare ICER thresholds to individual country's estimated ability-to-pay.


METHODS
We included AHRQ/USA, BIQG-GOEG/Austria, CADTH/Canada, DAHTA@DIMDI/Germany, DECIT-CGATS/Brazil, HAS/France, HITAP/Thailand, IQWiG/Germany, LBI-HTA/Austria, MSAC/Australia, NICE/England/Wales and SBU/Sweden. ICER thresholds were derived from systematic literature/website search/expert surveys. WTP was compared with ATP using Spearman's rank correlation.


RESULTS
Two general and explicitly acknowledged thresholds (England/Wales, Thailand), implicit thresholds in six countries and different ICER thresholds/decision-making rules in oncology were identified. Correlation between WTP and ability-to-pay was moderate.


CONCLUSIONS
Our overview supports country-specific discussions on WTP and on how to define value(s) within societies.
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.|Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria.
Ruth
R
Schwarzer
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.|Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria.
Ursula
U
Rochau
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.|Department of Pharmacotherapy, University of Utah, 30 South 2000, Salt Lake City, UT 84112, USA.
Kim
K
Saverno
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.|Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria.
Beate
B
Jahn
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.
Bernhard
B
Bornschein
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.
Nikolai
N
Muehlberger
Program on Health Policy, Administration, Economics & Law, Department of Public Health & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.
Magdalena
M
Flatscher-Thoeni
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.|Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria.
Petra
P
Schnell-Inderst
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.|Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria.
Gaby
G
Sroczynski
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.
Martina
M
Lackner
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.
Imke
I
Schall
F Hoffmann-La Roche AG, Market Access Policy, Grenzacher Str. 124, 4070 Basel, Switzerland.
Ansgar
A
Hebborn
Amgen, Department of Health Economics & Reimbursement, Dammstrasse 23, 6301 Zug, Switzerland.
Karl
K
Pugner
Novartis International AG, Government Affairs Europe, Novartis Campus, Fabrikstrasse 1, 4002 Basel, Switzerland.
Andras
A
Fehervary
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.|Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria.|Department of Pharmacotherapy, University of Utah, 30 South 2000, Salt Lake City, UT 84112, USA.|Program in Personalized Health Care, Outcomes Research Center, Department of Pharmacotherapy, University of Utah, 30 South 2000, Salt Lake City, UT 84112, USA.
Diana
D
Brixner
Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.|Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria.|Department of Health Policy & Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA 02115, USA.|Institute for Technology Assessment & Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac Street, Boston, MA 02114-4724, USA.
Uwe
U
Siebert
D003362:Cost-Benefit Analysis / Q000191:economics* / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D019057:Quality-Adjusted Life Years
cost–effectiveness thresholds; decision-making; health policy; reimbursement; technology assessment; willingness-to-pay