Does Health Technology Assessment guidance give adequate consideration to decisions about less costly and less effective alternatives?

TY - UNPB

T1 - Does Health Technology Assessment guidance give adequate consideration to decisions about less costly and less effective alternatives?

AU - Griffin, Susan

AU - Fusco, Francesco

AU - Naidoo, Bhash

AU - Taylor, Matthew

AU - Walker, Simon Mark

PY - 2020/11/4

Y1 - 2020/11/4

N2 - Cost-effectiveness analysis (CEA) plays a key role informing decision-making in healthcare and,consequently, the interpretation of its results is discussed in formal guidance from health technologyassessment (HTA) organisations. A body of research indicates different willingness to pay for moreeffective interventions than willingness to accept less effective interventions, which some suggestsupports application of different cost-effectiveness thresholds depending on whether anintervention is considered more or less effective than the comparator. We review the theoreticalbasis for the use of differential thresholds within HTA organisations, and question whether they arecompatible with coherent decisions and social values. The National Institute for Health and CareExcellence (NICE) is one such organisation, providing recommendations on which healthcareinterventions to adopt in the United Kingdom. NICE guidance describes the decision rules it employs,including comparing CEA results to a cost-effectiveness threshold that defines the boundariesbeyond which an intervention is no longer considered to provide value for money. Our review ofNICE guidance finds that it describes a common threshold range for all alternatives, in line with thetheoretical basis for a supply-side threshold. However, we also find that the guidance focuses on theapplication of the threshold as a decision rule for more effective and more expensive treatments,with less guidance provided on less effective and less expensive treatments. We make suggestionsfor how HTA organisations can better support application of decision rules to interventions that areless effective and less expensive.

AB - Cost-effectiveness analysis (CEA) plays a key role informing decision-making in healthcare and,consequently, the interpretation of its results is discussed in formal guidance from health technologyassessment (HTA) organisations. A body of research indicates different willingness to pay for moreeffective interventions than willingness to accept less effective interventions, which some suggestsupports application of different cost-effectiveness thresholds depending on whether anintervention is considered more or less effective than the comparator. We review the theoreticalbasis for the use of differential thresholds within HTA organisations, and question whether they arecompatible with coherent decisions and social values. The National Institute for Health and CareExcellence (NICE) is one such organisation, providing recommendations on which healthcareinterventions to adopt in the United Kingdom. NICE guidance describes the decision rules it employs,including comparing CEA results to a cost-effectiveness threshold that defines the boundariesbeyond which an intervention is no longer considered to provide value for money. Our review ofNICE guidance finds that it describes a common threshold range for all alternatives, in line with thetheoretical basis for a supply-side threshold. However, we also find that the guidance focuses on theapplication of the threshold as a decision rule for more effective and more expensive treatments,with less guidance provided on less effective and less expensive treatments. We make suggestionsfor how HTA organisations can better support application of decision rules to interventions that areless effective and less expensive.

KW - Cost‐effectiveness analysis

KW - willingness to pay

KW - willingness to accept

KW - opportunity cost

KW - cost‐effectiveness thresholds

KW - priority setting

M3 - Working paper

T3 - CHE Research Paper

BT - Does Health Technology Assessment guidance give adequate consideration to decisions about less costly and less effective alternatives?

PB - Centre for Health Economics, University of York

CY - York, UK

ER -