Fasseeh Ahmad N, Korra Nada, Elezbawy Baher, Sedrak Amal S, Gamal Mary, Eldessouki Randa, Eldebeiky Mariam, George Mohsen, Seyam Ahmed, Abourawash Asmaa, Khalifa Ahmed Y, Shaheen Mayada, Abaza Sherif, Kaló Zoltán
Faculty of Pharmacy Alexandria University, Alexandria, Egypt.
Syreon Middle East, Alexandria, Egypt.
J Egypt Public Health Assoc. 2024 Jun 3;99(1):12. doi: 10.1186/s42506-024-00159-7.
Cost-effectiveness analyses rarely offer useful insights to policy decisions unless their results are compared against a benchmark threshold. The cost-effectiveness threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain. This study aimed to identify CET values on a global scale, provide an overview of using multiple CETs, and propose a country-specific CET framework specifically tailored for Egypt. The proposed framework aims to consider the globally identified CETs, analyze global trends, and consider the local structure of Egypt's healthcare system.
We conducted a literature review to identify CET values, with a particular focus on understanding the basis of differentiation when multiple thresholds are present. CETs of different countries were reviewed from secondary sources. Additionally, we assembled an expert panel to develop a national CET framework in Egypt and propose an initial design. This was followed by a multistakeholder workshop, bringing together representatives of different governmental bodies to vote on the threshold value and finalize the recommended framework.
The average CET, expressed as a percentage of the gross domestic product (GDP) per capita across all countries, was 135%, with a range of 21 to 300%. Interestingly, while the absolute value of CET increased with a country's income level, the average CET/GDP per capita showed an inverse relationship. Some countries applied multiple thresholds based on disease severity or rarity. In the case of Egypt, the consensus workshop recommended a threshold ranging from one to three times the GDP per capita, taking into account the incremental relative quality-adjusted life years (QALY) gain. For orphan medicines, a CET multiplier between 1.5 and 3.0, based on the disease rarity, was recommended. A two-times multiplier was proposed for the private reimbursement threshold compared to the public threshold.
The CET values in most countries appear to be closely related to the GDP per capita. Higher-income countries tend to use a lower threshold as a percentage of their GDP per capita, contrasted with lower-income countries. In Egypt, experts opted for a multiple CET framework to assess the value of health technologies in terms of reimbursement and pricing.
成本效益分析很少能为政策决策提供有用的见解，除非将其结果与基准阈值进行比较。成本效益阈值（CET）代表实现单位健康收益可接受的最大货币价值。本研究旨在确定全球范围内的CET值，概述使用多个CET的情况，并为埃及提出一个专门定制的国家特定CET框架。拟议的框架旨在考虑全球确定的CET，分析全球趋势，并考虑埃及医疗保健系统的本地结构。
我们进行了文献综述以确定CET值，特别关注在存在多个阈值时理解差异的基础。从二手资料中审查了不同国家的CET。此外，我们组建了一个专家小组来制定埃及的国家CET框架并提出初步设计。随后举办了一次多利益相关方研讨会，召集不同政府机构的代表对阈值进行投票并确定推荐框架。
所有国家的平均CET以人均国内生产总值（GDP）的百分比表示为135%，范围为21%至300%。有趣的是，虽然CET的绝对值随着国家收入水平的提高而增加，但人均平均CET/GDP呈反比关系。一些国家根据疾病严重程度或罕见程度应用多个阈值。就埃及而言，共识研讨会建议阈值范围为人均GDP的1至3倍，同时考虑增量相对质量调整生命年（QALY）增益。对于孤儿药，根据疾病罕见程度，建议CET乘数在1.5至3.0之间。与公共阈值相比，私人报销阈值建议乘数为2倍。
大多数国家的CET值似乎与人均GDP密切相关。高收入国家倾向于使用较低的阈值（占其人均GDP的百分比），这与低收入国家形成对比。在埃及，专家们选择了一个多CET框架来评估卫生技术在报销和定价方面的价值。
