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Cost-effectiveness Threshold and Health Opportunity Cost
With the setting up of the health technology assessment board, evidence from cost-effectiveness analysis will play an important role in decision-making. This raises the fundamental question: How much extra cost per unit of health gained is considered cost-effective? Various approaches for assessing the appropriate cost-effectiveness threshold for India are discussed. A robustly determined opportunity cost of healthcare spending should serve as a proxy for setting up a CET, and it should be used to advocate for greater resources towards achieving universal health coverage.
Shankar Prinja (shankarprinja@gmail.com) teaches at the School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh. Thiagarajan Sundararaman (t.sundararaman@tiss.edu) is with the Tata Institute of Social Sciences, Mumbai. V R Muraleedharan (vrm@iitm.ac.in) is with the Indian Institute of Technology Madras, Chennai.
India has made a beginning with institutionalising health technology assessment (HTA) for contributing evidence to strengthen policymaking with respect to universal health coverage (UHC), for evolving standard treatment guidelines and for generating evidence on value for money for a variety of health interventions and choice of technologies (Downey et al 2017; Prinja et al 2018). While four HTA reports have already been submitted, nearly a dozen others have been commissioned to technical partners (Department of Health Research 2018a). The secretariat for the agency—Health Technology Assessment India (HTAIn)—set up in the Department of Health Research, has recently published the methods manual, which is a practical guide for both technical partners, who are undertaking HTA studies, as well as the users of HTA evidence (Department of Health Research 2018b). However, one of the key issues, which is critical to decision-making, has not been yet addressed: what is the cost-effectiveness threshold (CET) that HTAIn should use to judge the interventions that are currently being evaluated or have been evaluated?
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