Affordability and Value in Decision Rules for Cost-Effectiveness: A Survey of Health Economists.

Autor: Bilinski A; Brown School of Public Health, Providence, RI, USA. Electronic address: alyssa_bilinski@brown.edu., MacKay E; Harvard Graduate School of Arts and Sciences, Cambridge, MA, USA., Salomon JA; Stanford University School of Medicine, Stanford, CA, USA., Pandya A; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research [Value Health] 2022 Jul; Vol. 25 (7), pp. 1141-1147. Date of Electronic Publication: 2022 Feb 24.
DOI: 10.1016/j.jval.2021.11.1375
Abstrakt: Objectives: New health technologies are often expensive, but may nevertheless meet standard thresholds for cost effectiveness, a situation exemplified by recent hepatitis C cures. Currently, cost-effectiveness analysis (CEA) does not supply practical means of weighing trade-offs between cost-effectiveness and affordability, particularly when costs and benefits are temporally separated and in health systems with multiple payers, such as the United States. We formally characterized disagreements in CEA theory and identified how these trade-offs are presently addressed in practice.
Methods: We surveyed 170 health economics researchers.
Results: When presented with a hypothetical cost-effective drug therapy in the United States that would require 20% of a state's Medicaid budget over 5 years, 34% of survey respondents recommended that policy makers fund the drug for all patients and 26% for a subset. By contrast, 26% recommended against funding the drug. We found additional disagreement regarding whether the willingness-to-pay threshold should be based on the budget (42%) or societal preferences (41%) and identified 4 approaches to weighing cost-effectiveness and affordability. A total of 61% of respondents did not believe that the threshold used in their last article (most often 1×-3× per capita gross domestic product) represented either the budget or societal willingness-to-pay threshold.
Conclusions: We use these findings to recommend metrics that can inform translation of CEA theory into practice. By contextualizing cost and value, researchers can provide more actionable policy recommendations.
(Copyright © 2022. Published by Elsevier Inc.)
Databáze: MEDLINE
Externí odkaz: