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. 2024 Jun 3;99(1):12.
doi: 10.1186/s42506-024-00159-7.

Framework for developing cost-effectiveness analysis threshold: the case of Egypt

Ahmad N Fasseeh  1   2 , Nada Korra  3 , Baher Elezbawy  2 , Amal S Sedrak  4   5 , Mary Gamal  5 , Randa Eldessouki  6 , Mariam Eldebeiky  5 , Mohsen George  7 , Ahmed Seyam  7 , Asmaa Abourawash  8 , Ahmed Y Khalifa  9 , Mayada Shaheen  10 , Sherif Abaza  2 , Zoltán Kaló  11   12
Affiliations

Framework for developing cost-effectiveness analysis threshold: the case of Egypt

Ahmad N Fasseeh et al. J Egypt Public Health Assoc. .

Erratum in

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: CET; Cost-effectiveness threshold; Cost-effectiveness threshold multiplier; Egypt; Incremental relative QALY gain; Multiple thresholds.

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Conflict of interest statement

Syreon Middle East was a contractual partner of Roche Egypt. A. F. and S. A. are shareholders in Syreon Middle East. N. K. is an employee at Syreon Middle East. M. S. is an employee at Roche Egypt. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CET absolute value USD 2019 box-and-whisker diagram. CET, cost-effectiveness threshold. GDP, gross domestic product
Fig. 2
Fig. 2
CET as a ratio of GDP per capita (nominal) box-and-whisker diagram. CET, cost-effectiveness threshold. GDP, gross domestic product
Fig. 3
Fig. 3
CET VS GDP per capita for types of thresholds using CET lower values. CET, cost-effectiveness threshold. GDP, gross domestic product
Fig. 4
Fig. 4
CET/GDP per capita vs GDP per capita for types of thresholds using CET lower values. CET, cost-effectiveness threshold. GDP, gross domestic product
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