Estimating the Reference Incremental Cost-Effectiveness Ratio for the Australian Health System

Autor: Jonathan Karnon, Hossein Haji Ali Afzali, Terence Chai Cheng, Laura Catherine Edney
Rok vydání: 2017
Předmět:
medicine.medical_specialty
Financing
Government
Technology Assessment
Biomedical
Cost-Benefit Analysis
Population
Decision Making
Biomedical Technology
Population health
03 medical and health sciences
0302 clinical medicine
Health care
Economics
medicine
Humans
030212 general & internal medicine
Least-Squares Analysis
education
health care economics and organizations
Pharmacology
education.field_of_study
Actuarial science
Health economics
Cost–benefit analysis
business.industry
030503 health policy & services
Health Policy
Public health
Public Health
Environmental and Occupational Health
Australia
Quality-adjusted life year
Quality of Life
Regression Analysis
Quality-Adjusted Life Years
Health Expenditures
0305 other medical science
business
Incremental cost-effectiveness ratio
Delivery of Health Care
Zdroj: PharmacoEconomics. 36(2)
ISSN: 1179-2027
Popis: Spending on new healthcare technologies increases net population health when the benefits of a new technology are greater than their opportunity costs—the benefits of the best alternative use of the additional resources required to fund a new technology. The objective of this study was to estimate the expected incremental cost per quality-adjusted life-year (QALY) gained of increased government health expenditure as an empirical estimate of the average opportunity costs of decisions to fund new health technologies. The estimated incremental cost-effectiveness ratio (ICER) is proposed as a reference ICER to inform value-based decision making in Australia. Empirical top-down approaches were used to estimate the QALY effects of government health expenditure with respect to reduced mortality and morbidity. Instrumental variable two-stage least-squares regression was used to estimate the elasticity of mortality-related QALY losses to a marginal change in government health expenditure. Regression analysis of longitudinal survey data representative of the general population was used to isolate the effects of increased government health expenditure on morbidity-related, QALY gains. Clinical judgement informed the duration of health-related quality-of-life improvement from the annual increase in government health expenditure. The base-case reference ICER was estimated at AUD28,033 per QALY gained. Parametric uncertainty associated with the estimation of mortality- and morbidity-related QALYs generated a 95% confidence interval AUD20,758–37,667. Recent public summary documents suggest new technologies with ICERs above AUD40,000 per QALY gained are recommended for public funding. The empirical reference ICER reported in this article suggests more QALYs could be gained if resources were allocated to other forms of health spending.
Databáze: OpenAIRE
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