A cost-effectiveness threshold based on the marginal returns of cardiovascular hospital spending

Pieter van Baal, Meg Perry-Duxbury, Pieter Bakx, Matthijs Versteegh, Eddy van Doorslaer, Werner Brouwer

Research output: Contribution to journalArticleScientificpeer-review

12 Citations (Scopus)

Abstract

Traditionally, threshold levels of cost-effectiveness have been derived from willingness-to-pay studies, indicating the consumption value of health (v-thresholds). However, it has been argued that v-thresholds need to be supplemented by so-called k-thresholds, which are based on the marginal returns to health care. The objective of this research is to estimate a k-threshold based on the marginal returns to cardiovascular disease (CVD) hospital care in the Netherlands. To estimate a k-threshold for hospital care on CVD, we proceed in two steps: First, we estimate the impact of hospital spending on mortality using a Bayesian regression modelling framework, using data on CVD mortality and CVD hospital spending by age and gender for the period 1994–2010. Second, we use life tables in combination with quality of life data to convert these estimates into a k-threshold expressed in euros per quality-adjusted life year gained. Our base case estimate resulted in an estimate of 41,000 per quality-adjusted life year gained. In our sensitivity analyses, we illustrated how the incorporation of prior evidence into the estimation pushes estimates downwards. We conclude that our base case estimate of the k-threshold may serve as a benchmark value for decision making in the Netherlands as well as for future research regarding k-thresholds.

Original languageEnglish
Pages (from-to)87-100
Number of pages14
JournalHealth Economics (United Kingdom)
Volume28
Issue number1
DOIs
Publication statusPublished - Jan 2019
Externally publishedYes

Keywords

  • Bayesian statistics
  • cost-effectiveness analysis
  • opportunity costs
  • threshold

Fingerprint Dive into the research topics of 'A cost-effectiveness threshold based on the marginal returns of cardiovascular hospital spending'. Together they form a unique fingerprint.

Cite this