Cost-effectiveness in practice

J. Zwaap, S. Knies, C. van der Meijden, et al. Report by Dutch Health Care Institute, 26th of June 2015

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This report proposes reference values that vary based on the burden of disease calculated according to the proportional shortfall method. Research into existing solidarity in health care shows that our society feels higher costs per QALY are justifiable when serious diseases are involved. Since the RVZ report, Justifiable and sustainable care (2006), the societal debate makes use of a cost ranging from 10,000 euro/QALY with a low proportional shortfall, to 80,000 euro per QALY with a high proportional shortfall. For the moment, the Zorginstituut has adopted this range as basis. It can of course always be adjusted based on (inter)national research.As point estimates are involved both for cost-effectiveness and for proportional shortfall, we prefer to classify into three classes instead of using a sliding scale.