TY - JOUR

T1 - Supply-side cost-effectiveness thresholds: questions for evidence-based policy

AU - Sampson, Chris

AU - Zamora, Bernarda

AU - Watson, Sam

AU - Cairns, John

AU - Chalkidou, Kalipso

AU - Cubi-Molla, Patricia

AU - Devlin, Nancy

AU - García-Lorenzo, Borja

AU - Hughes, Dyfrig

AU - Leech, Ashley

AU - Towse, Adrian

PY - 2022/9

Y1 - 2022/9

N2 - There is growing interest in cost-effectiveness thresholds as a tool to inform resource allocation decisions in health care. Studies from several countries have sought to estimate health system opportunity costs, which supply-side cost-effectiveness thresholds are intended to represent. In this paper, we consider the role of empirical estimates of supply-side thresholds in policy-making. Recent studies estimate the cost per unit of health based on average displacement or outcome elasticity. We distinguish the types of point estimates reported in empirical work, including marginal productivity, average displacement, and outcome elasticity. Using this classification, we summarise the limitations of current approaches to threshold estimation in terms of theory, methods, and data. We highlight the questions that arise from alternative interpretations of thresholds and provide recommendations to policymakers seeking to use a supply-side threshold where the evidence base is emerging or incomplete. We recommend that: i) policymakers must clearly define the scope of the application of a threshold, and the theoretical basis for empirical estimates should be consistent with that scope; ii) a process for the assessment of new evidence and for determining changes in the threshold to be applied in policy-making should be created; iii) decision-making processes should retain flexibility in the application of a threshold, and iv) policymakers should provide support for decision-makers relating to the use of thresholds and the implementation of decisions stemming from their application.

AB - There is growing interest in cost-effectiveness thresholds as a tool to inform resource allocation decisions in health care. Studies from several countries have sought to estimate health system opportunity costs, which supply-side cost-effectiveness thresholds are intended to represent. In this paper, we consider the role of empirical estimates of supply-side thresholds in policy-making. Recent studies estimate the cost per unit of health based on average displacement or outcome elasticity. We distinguish the types of point estimates reported in empirical work, including marginal productivity, average displacement, and outcome elasticity. Using this classification, we summarise the limitations of current approaches to threshold estimation in terms of theory, methods, and data. We highlight the questions that arise from alternative interpretations of thresholds and provide recommendations to policymakers seeking to use a supply-side threshold where the evidence base is emerging or incomplete. We recommend that: i) policymakers must clearly define the scope of the application of a threshold, and the theoretical basis for empirical estimates should be consistent with that scope; ii) a process for the assessment of new evidence and for determining changes in the threshold to be applied in policy-making should be created; iii) decision-making processes should retain flexibility in the application of a threshold, and iv) policymakers should provide support for decision-makers relating to the use of thresholds and the implementation of decisions stemming from their application.

M3 - Article

VL - 20

SP - 651

EP - 667

JO - Applied Health Economics and Health Policy

JF - Applied Health Economics and Health Policy

SN - 1175-5652

IS - 5

ER -