Cost-effectiveness thresholds: Changes, challenges and consequences
In the UK, POLITICO reported a planned 25% increase to NICE’s cost-effectiveness threshold, likely tied to the possibility of averting US tariffs on imported pharmaceuticals. If this change does take place, it will be an unprecedented change to NICE’s cost-effectiveness threshold (CET), which has remained unchanged for over 20 years.
Health systems’ ability and willingness to pay continue to be an urgent global debate. Last month, we looked at Saudi Arabia’s recently formalised HTA framework in our ‘Around the World in HTA Series’ where cost-effectiveness plays a key factor, with an informal willingness-to-pay threshold of around 13,000-20,000 USD per QALY, though flexibility is anticipated.
OHE authors have worked extensively on this topic, including recommendations for policymakers on supply-side thresholds, and a whitepaper on the relative merits and shortfalls of current approaches to defining, estimating and applying CET, including whether multiple thresholds reflecting value elements beyond the QALY may be needed. Last year, my colleague Chris Sampson and I also suggested that historical marginal cost per QALY estimates are better suited to exploring the consequences of changes in expenditure than for setting strict thresholds.
Whatever happens in the UK, it's clear that increasingly, the value new treatments offer is challenging current budget frameworks payment tools. This gets to the heart of our work at OHE: generating evidence to support healthcare decisions that achieve the best outcomes for patients, health systems, and innovators.
