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Estimating the Reference Incremental Cost-Effectiveness Ratio for the Australian Health System

Author

Listed:
  • Laura Catherine Edney

    (University of Adelaide)

  • Hossein Haji Ali Afzali

    (University of Adelaide)

  • Terence Chai Cheng

    (University of Adelaide)

  • Jonathan Karnon

    (University of Adelaide)

Abstract

Background Spending on new healthcare technologies increases net population health when the benefits of a new technology are greater than their opportunity costs—the benefits of the best alternative use of the additional resources required to fund a new technology. Objective The objective of this study was to estimate the expected incremental cost per quality-adjusted life-year (QALY) gained of increased government health expenditure as an empirical estimate of the average opportunity costs of decisions to fund new health technologies. The estimated incremental cost-effectiveness ratio (ICER) is proposed as a reference ICER to inform value-based decision making in Australia. Methods Empirical top-down approaches were used to estimate the QALY effects of government health expenditure with respect to reduced mortality and morbidity. Instrumental variable two-stage least-squares regression was used to estimate the elasticity of mortality-related QALY losses to a marginal change in government health expenditure. Regression analysis of longitudinal survey data representative of the general population was used to isolate the effects of increased government health expenditure on morbidity-related, QALY gains. Clinical judgement informed the duration of health-related quality-of-life improvement from the annual increase in government health expenditure. Results The base-case reference ICER was estimated at AUD28,033 per QALY gained. Parametric uncertainty associated with the estimation of mortality- and morbidity-related QALYs generated a 95% confidence interval AUD20,758–37,667. Conclusion Recent public summary documents suggest new technologies with ICERs above AUD40,000 per QALY gained are recommended for public funding. The empirical reference ICER reported in this article suggests more QALYs could be gained if resources were allocated to other forms of health spending.

Suggested Citation

  • Laura Catherine Edney & Hossein Haji Ali Afzali & Terence Chai Cheng & Jonathan Karnon, 2018. "Estimating the Reference Incremental Cost-Effectiveness Ratio for the Australian Health System," PharmacoEconomics, Springer, vol. 36(2), pages 239-252, February.
    • Handle: RePEc:spr:pharme:v:36:y:2018:i:2:d:10.1007_s40273-017-0585-2
    DOI: 10.1007/s40273-017-0585-2
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    References listed on IDEAS

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    1. Appleby, John & Devlin, Nancy & Parkin, David & Buxton, Martin & Chalkidou, Kalipso, 2009. "Searching for cost effectiveness thresholds in the NHS," Health Policy, Elsevier, vol. 91(3), pages 239-245, August.
    2. Rohde, Nicholas & Tang, K.K. & Osberg, Lars & Rao, Prasada, 2016. "The effect of economic insecurity on mental health: Recent evidence from Australian panel data," Social Science & Medicine, Elsevier, vol. 151(C), pages 250-258.
    3. Karlsberg Schaffer, Sarah & Sussex, Jon & Devlin, Nancy & Walker, Andrew, 2015. "Local health care expenditure plans and their opportunity costs," Health Policy, Elsevier, vol. 119(9), pages 1237-1244.
    4. Dahlgren, Göran & Whitehead, Margaret, 1991. "Policies and strategies to promote social equity in health. Background document to WHO - Strategy paper for Europe," Arbetsrapport 2007:14, Institute for Futures Studies.
    5. Davidson, Russell & MacKinnon, James G., 1993. "Estimation and Inference in Econometrics," OUP Catalogue, Oxford University Press, number 9780195060119.
    6. Beth Woods & Paul Revill & Mark Sculpher & Karl Claxton, 2015. "Country-level cost-effectiveness thresholds: initial estimates and the need for further research," Working Papers 109cherp, Centre for Health Economics, University of York.
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Opportunity costs, marginal productivity, and cost-effectiveness thresholds: what are they and how are they related?
      by Rita Faria, Jessica Ochalek, jameslomas88 in The Academic Health Economists' Blog on 2020-09-23 06:00:00

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