Decision rules in cost-effectiveness/cost-utility analysis of healthcare programs

Abstract

The objectives of this study were: 1) to identify alternative decision rules of threshold incremental cost-effectiveness ratio (ICER) used in cost-effectiveness/cost-utility analysis of healthcare programs and 2) to compare advantages and disadvantages of those alternatives with the threshold ICER. The research methods used were described as follows. Literatures were reviewed to identify alternative decision rules. Their advantages and disadvantages were compared with the threshold ICER including both theoretical and considerations. Experiences from countries with publicly-funded healthcare system were reviewed. Secondary data were used to compare performances of those decision rules. Major findings were presented as follows. 1) Alternative to the threshold ICER, the decision making (DM) plan should be applied under fixed budget. The modified league table should be applied under the situation where budget expansion was possible. Information from ICER was still useful and should be included in the league table. ICER was more informative as a part of league table than compared with the threshold ICER. 2) The threshold ICER had shortcomings compared to other alternatives. Current application of the threshold ICER potentially led to uncertain situations. The threshold approach could be misleading and might not ensure economic efficiency. Finally, a new framework was constructed in which policymakers must recognize their budget situation before making decision.