Severity-Adjusted Probability of Being Cost Effective

Overview

Journal Pharmacoeconomics

Specialty Pharmacology

Date 2019 May 29

PMID 31134467

Citations 36

Authors

Matthijs M Versteegh

Isaac Corro Ramos

Nasuh C Buyukkaramikli

Amir Ansaripour

Vivian T Reckers-Droog

Werner B F Brouwer

Affiliations

Soon will be listed here.

Abstract

Background: In the context of priority setting, a differential cost-effectiveness threshold can be used to reflect a higher societal willingness to pay for quality-adjusted life-year gains in the worse off. However, uncertainty in the estimate of severity can lead to problems when evaluating the outcomes of cost-effectiveness analyses.

Objectives: This study standardizes the assessment of severity, integrates its uncertainty with the uncertainty in cost-effectiveness results and provides decision makers with a new estimate: the severity-adjusted probability of being cost effective.

Methods: Severity is expressed in proportional and absolute shortfall and estimated using life tables and country-specific EQ-5D values. We use the three severity-based cost-effectiveness thresholds (€20.000, €50.000 and €80.000, per QALY) adopted in The Netherlands. We exemplify procedures of integrating uncertainty with a stylized example of a hypothetical oncology treatment.

Results: Applying our methods, taking into account the uncertainty in the cost-effectiveness results and in the estimation of severity identifies the likelihood of an intervention being cost effective when there is uncertainty about the appropriate severity-based cost-effectiveness threshold.

Conclusions: Higher willingness-to-pay thresholds for severe diseases are implemented in countries to reflect societal concerns for an equitable distribution of resources. However, the estimates of severity are uncertain, patient populations are heterogeneous, and this can be accounted for with the severity-adjusted probability of being cost effective proposed in this study. The application to the Netherlands suggests that not adopting the new method could result in incorrect decisions in the reimbursement of new health technologies.

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References

van de Wetering E, Stolk E, van Exel N, Brouwer W . Balancing equity and efficiency in the Dutch basic benefits package using the principle of proportional shortfall. Eur J Health Econ. 2011; 14(1):107-15. PMC: 3535361. DOI: 10.1007/s10198-011-0346-7. View

Corro Ramos I, M Versteegh M, de Boer R, Koenders J, Linssen G, Meeder J . Cost Effectiveness of the Angiotensin Receptor Neprilysin Inhibitor Sacubitril/Valsartan for Patients with Chronic Heart Failure and Reduced Ejection Fraction in the Netherlands: A Country Adaptation Analysis Under the Former and Current Dutch.... Value Health. 2017; 20(10):1260-1269. DOI: 10.1016/j.jval.2017.05.013. View

Hernaes U, Johansson K, Ottersen T, Norheim O . Distribution-Weighted Cost-Effectiveness Analysis Using Lifetime Health Loss. Pharmacoeconomics. 2017; 35(9):965-974. DOI: 10.1007/s40273-017-0524-2. View

van Hout B, Al M, Gordon G, Rutten F . Costs, effects and C/E-ratios alongside a clinical trial. Health Econ. 1994; 3(5):309-19. DOI: 10.1002/hec.4730030505. View

Paulden M, OMahony J, Culyer A, McCabe C . Some inconsistencies in NICE's consideration of social values. Pharmacoeconomics. 2014; 32(11):1043-53. DOI: 10.1007/s40273-014-0204-4. View

Nord E, Johansen R . Concerns for severity in priority setting in health care: a review of trade-off data in preference studies and implications for societal willingness to pay for a QALY. Health Policy. 2014; 116(2-3):281-8. DOI: 10.1016/j.healthpol.2014.02.009. View

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D . Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011; 20(10):1727-36. PMC: 3220807. DOI: 10.1007/s11136-011-9903-x. View

Wailoo A, Tsuchiya A, McCabe C . Weighting must wait: incorporating equity concerns into cost-effectiveness analysis may take longer than expected. Pharmacoeconomics. 2009; 27(12):983-9. DOI: 10.2165/11314100-000000000-00000. View

Norheim O, Baltussen R, Johri M, Chisholm D, Nord E, Brock D . Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Eff Resour Alloc. 2014; 12:18. PMC: 4171087. DOI: 10.1186/1478-7547-12-18. View

10.

Heijink R, van Baal P, Oppe M, Koolman X, Westert G . Decomposing cross-country differences in quality adjusted life expectancy: the impact of value sets. Popul Health Metr. 2011; 9(1):17. PMC: 3146826. DOI: 10.1186/1478-7954-9-17. View

11.

Reckers-Droog V, van Exel N, Brouwer W . Looking back and moving forward: On the application of proportional shortfall in healthcare priority setting in the Netherlands. Health Policy. 2018; 122(6):621-629. DOI: 10.1016/j.healthpol.2018.04.001. View

12.

Wagstaff A . QALYs and the equity-efficiency trade-off. J Health Econ. 1991; 10(1):21-41. DOI: 10.1016/0167-6296(91)90015-f. View

13.

van Baal P, Perry-Duxbury M, Bakx P, Versteegh M, van Doorslaer E, Brouwer W . A cost-effectiveness threshold based on the marginal returns of cardiovascular hospital spending. Health Econ. 2018; 28(1):87-100. PMC: 6585934. DOI: 10.1002/hec.3831. View

14.

Ottersen T, Forde R, Kakad M, Kjellevold A, Melberg H, Moen A . A new proposal for priority setting in Norway: Open and fair. Health Policy. 2016; 120(3):246-51. DOI: 10.1016/j.healthpol.2016.01.012. View

15.

Bobinac A, van Exel N, Rutten F, Brouwer W . Inquiry into the relationship between equity weights and the value of the QALY. Value Health. 2012; 15(8):1119-26. DOI: 10.1016/j.jval.2012.07.002. View

16.

Shah K . Severity of illness and priority setting in healthcare: a review of the literature. Health Policy. 2009; 93(2-3):77-84. DOI: 10.1016/j.healthpol.2009.08.005. View

17.

Claxton K, Paulden M, Gravelle H, Brouwer W, Culyer A . Discounting and decision making in the economic evaluation of health-care technologies. Health Econ. 2010; 20(1):2-15. DOI: 10.1002/hec.1612. View

18.

M Versteegh M, Vermeulen K, Evers S, de Wit G, Prenger R, Stolk E . Dutch Tariff for the Five-Level Version of EQ-5D. Value Health. 2016; 19(4):343-52. DOI: 10.1016/j.jval.2016.01.003. View

19.

Hernandez-Alava M, Pudney S . Econometric modelling of multiple self-reports of health states: The switch from EQ-5D-3L to EQ-5D-5L in evaluating drug therapies for rheumatoid arthritis. J Health Econ. 2017; 55:139-152. PMC: 5597047. DOI: 10.1016/j.jhealeco.2017.06.013. View

20.

Stolk E, van Donselaar G, Brouwer W, Busschbach J . Reconciliation of economic concerns and health policy: illustration of an equity adjustment procedure using proportional shortfall. Pharmacoeconomics. 2004; 22(17):1097-107. DOI: 10.2165/00019053-200422170-00001. View