Definitions
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Cost-effectiveness threshold (CET): represents the maximum acceptable monetary value for achieving a unit of health gain
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
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
The GDP per capita approach uses the country's Gross Domestic Product per capita as a benchmark for the value of CET.
The demand-side approach incorporates population preferences through methods like contingent valuation surveys to determine the CET; so, it is linked to societal perspective.
The supply-side approach considers the values associated with relocating healthcare resources; so, it is linked to a health care perspective
Contingent valuation surveys: To assess the WTP for a reduction in mortality risk or the willingness-to-accept for a risk aversion. The survey focuses on eliciting the maximum amount individuals are willing to pay for a small health gain, and then aggregates the WTP needed to gain a QALY
Value of statistical life: The amount society is willing to pay to reduce the risk of death. Indirect VSL approaches are based on already available information, which could consist of already known VSL values, the prospect theory, or legal practices
League tables: Method for prioritizing different technologies within a fixed budget. A league table consists of health technologies listed in order of their ICER. It facilitates the allocation of healthcare resources until the budget is exhausted
Opportunity costs: Represent the benefits forgone when resources are allocated to one activity over another. Consequently, interventions are considered cost-effective if they generate more health benefits than alternative interventions that could have been funded with the same resources
Precedent method: Based on the value of technology already approved for funding, known as the precedent method. This approach utilizes the ICER of earlier funded technologies as benchmarks to gauge the acceptability of new technologies
Severity of the disease: Burden of illness: it reflects the overall burden of the disease on the individual’s health and quality of life.
Mild, moderate and severe
e.g., severe conditions also include end-of-life diseases, e.g. applied to diseases including conditions characterised by poor quality of life like non-end-of-life cancers as well as non-cancer conditions that have dramatic and far-reaching impacts on patients, such as cystic fibrosis and chronic hepatitis D.
Rarity of the disease: Reflects the number of individuals affected by a particular disease within a specified population, indicating the rarity of the condition
Rare diseases or conditions are uncommon and often serious and long-lasting
Rare (<50 per 100.000), Uncommon (50-500 per 100.000), Common (500> per 100.000).
Unmet needs: Health conditions or symptoms for which there are insufficient effective treatments available, including conditions that lack any existing therapies, as well as those for which current options are inadequate, ineffective, or not universally accessible.
Degree of innovation: Level of novelty and transformative impact of new or improved healthcare solutions aimed at enhancing patient outcomes and healthcare delivery; It encompasses a wide range of advancements, including novel technologies, methods, and services that can significantly improve the efficiency and effectiveness of healthcare systems.
Age: Age groups: children (0-18), adults (19-64), and elderly (65+)
e.g., younger age groups may be favoured.
Therapeutic value: Clinical benefit - positive impact of a treatment or intervention on a patient’s health, including improvements in how the patient feels, functions, or survives. It can be measured by improvements in symptoms, functionality, or overall well-being, and is reflected in meaningful, measurable changes that are relevant to the patient’s experience.
Social value: Broader societal benefits (public health impact) - refer to the extensive positive or negative effects that healthcare policies, programs, or projects have on the overall health and well-being of a population; encompasses not only direct health outcomes but also the wider implications for social determinants of health, including economic productivity, quality of life, and the burden of informal caregiving.
End-of-life: Health technologies that extend the life in the end-of-life diseases, in terminal conditions such as cancer.
Productivity: Workplace (labour) productivity: health technology has an impact on workplace productivity.
Adherence-improving factors: Features of the treatment itself improve adherence with the treatment, e.g. medical technologies offer advantages over existing alternatives such as simpler dosing schedules, alternate routes of administration, or combination treatments.
Reduction in uncertainty: Uncertainty arises from various factors, including variability in patient responses, limitations in study designs, and incomplete or inconclusive data regarding long-term effects.
e.g., treatment is accompanied by a new diagnostic test that would differentiate “good responders” and “poor responders”, or some types of diagnostics might predict treatment effectiveness more accurately.
Fear of contagion: Fear associated with the spread of infectious disease.
Insurance value: Has two components—physical risk protection and financial risk protection, e.g. new medical technology reduces the “physical risk” of getting sick and new medical technologies make financial insurance policies more useful.
Value of hope: It revolves around the risk that a particular treatment may or may not work for a particular patient.
Real option value: When a health technology that extends life creates opportunities for the patient to benefit from other future advances in medicine.
Equity: Principle that all individuals, regardless of their socioeconomic background, race, gender, disability, or other personal circumstances, should have a fair and just opportunity to achieve optimal health. Achieving equity involves identifying and addressing systemic and avoidable barriers to care, ensuring that disparities in access, quality, and health outcomes are minimized or eliminated. More than a practical aim, health equity represents an ethical commitment to human rights, asserting that health and well-being should not be dictated by social or demographic factors.
Environmental impact: Refers to the effects that specific activities, projects, or technologies have on the natural environment, e.g. positive effect on the environment, a neutral effect on the environment and a negative impact on the environment.
Scientific spillovers: Relevant when technology identifies a new mechanism of action or mode of delivery; have impact of a new technology on future generations of patients.