Definitions

Approach for deriving the Cost-Effectiveness Threshold

Demand-Side Approach: This approach suggests that individuals are best positioned to make decisions about maximizing their own health utility, emphasizing the importance of aligning budget allocation with societal preferences. In this context, CETs are determined by assessing willingness-to-pay through contingent valuation surveys or using the value of statistical life methods.

Supply-Side Approach: This approach suggests that healthcare resource allocation should be guided by the opportunity cost approach. When resources are reallocated, new investments displace existing services, so the CET should reflect the value of the health benefits forgone by the best alternative use of the resources. Key methods include league tables, which rank interventions by ICER.

Definition

Explicit thresholds: Those officially published and available in the public domain, such as on an official website.

Implicit thresholds: Defined as those used for decision-making without formal publication.

Economic evaluation: It assesses value for money by comparing two or more interventions based on costs and health outcomes. It generates evidence-based information, mainly through cost-effectiveness analysis or cost-benefit analysis, to assist and improve decision making of allocating health care resources.

Modifiers: Characteristics that decision makers use to vary the level of the CET; these characteristics could be related to the intervention, the specific medical condition(s), or the targeted population.

Possible Modifiers of CET	Definition
Adherence Effect	Innovations that improve the likelihood of patients following their prescribed treatment, maximizing effectiveness. Examples include less invasive administration methods, simpler dosing schedules, and combination treatments that reduce complexity.
Age	Age is the total length of time a person has lived, measured from their date of birth to the present moment.
Disease Risk Reduction (insurance value)	Reducing future health risks for non-patients, providing peace of mind that effective treatments exist if illness occurs. This includes better expected health outcomes and reduced uncertainty about future health.
Disease Severity	The seriousness of a health condition, measured by the intensity of symptoms, impact on daily life, and the potential for severe outcomes such as disability or death. It reflects the extent to which a disease harms a person’s health and well-being.
End-of-Life	Health technologies applied during the final stages of life, often in terminal conditions such as advanced cancer, focusing on extending life or improving quality of life during this period.
Environmental Impact	The effects of activities, projects, or technologies on the natural environment, such as impacts on ecosystems, air and water quality, greenhouse gas emissions, resource depletion, waste generation, and biodiversity. In healthcare, this includes evaluating the consequences of manufacturing, transporting, and using medical treatments and technologies.
Equity	Reducing health disparities across patient subgroups such as socioeconomic status, race, ethnicity, gender, geography, or disability. Equity emphasizes fair opportunities for optimal health by addressing systemic barriers and minimizing disparities in access, quality, and outcomes.
Family and Caregiver Spillover	The impact of treatments on the well-being of family members and caregivers, including reduced caregiver burdens such as productivity loss, diminished quality of life, and indirect costs associated with providing care.
Fear of Contagion	The influence of fear surrounding the spread of infectious diseases, which can affect economic activity, business operations, and the healthcare sector by driving precautionary behaviors and resource allocation.
Indirect Resource Benefits	The benefits of treatments that reduce the need for critical healthcare resources. For example, hepatitis C treatments lower demand for liver transplants, increasing the availability of donor organs for patients with incurable diseases.
Productivity	The reduction of market and non-market output losses due to effective treatment of a disease. This includes both direct improvements in individuals' ability to work and broader economic spillovers such as increased labour participation and reduced societal costs.
Rarity of Disease	A condition is considered rare when it affects a small proportion of the population, defined in the European Union as no more than 50 per 100,000 people. Rare diseases are often inheritable, life-threatening, and severely disabling.
Scientific Spillover	The innovation triggered by the development of a technology, including advances in knowledge and new mechanisms of action. These innovations pave the way for future breakthroughs across therapeutic classes and benefit future generations of patients.
Uncertainty reduction	Minimizing variability in health outcomes, which reflects preferences for greater predictability. Uncertainty arises from differences in patient responses, study limitations, or incomplete data on long-term effects.
Unmet Need	Health conditions or symptoms that lack effective treatments, or where existing options are insufficient, inadequate, or inaccessible. This includes conditions with no available therapies or limited efficacy.
Value of Hope	The potential for highly favourable outcomes from treatment, particularly in cases with variable responses. This captures differences in risk tolerance, where some patients seek the chance of excellent outcomes, while others may prefer predictable treatments with lower variability.
Value of Knowing	Improved diagnostics that reduce uncertainty about a patient’s current health status, enabling more informed and accurate treatment decisions.