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Type: Journal article
Title: Estimating the reference incremental cost-effectiveness ratio for the Australian health system
Author: Edney, L.
Haji Ali Afzali, H.
Cheng, T.
Karnon, J.
Citation: PharmacoEconomics, 2018; 36(2):239-252
Publisher: Adis International
Issue Date: 2018
ISSN: 1170-7690
Statement of
Laura Catherine Edney, Hossein Haji Ali Afzali, Terence Chai Cheng, Jonathan Karnon
Abstract: Background: Spending on new healthcare technologies increases net population health when the benefits of a new technology are greater than their opportunity costs—the benefits of the best alternative use of the additional resources required to fund a new technology. Objective: The objective of this study was to estimate the expected incremental cost per quality-adjusted life-year (QALY) gained of increased government health expenditure as an empirical estimate of the average opportunity costs of decisions to fund new health technologies. The estimated incremental cost-effectiveness ratio (ICER) is proposed as a reference ICER to inform value-based decision making in Australia. Methods: Empirical top-down approaches were used to estimate the QALY effects of government health expenditure with respect to reduced mortality and morbidity. Instrumental variable two-stage least-squares regression was used to estimate the elasticity of mortality-related QALY losses to a marginal change in government health expenditure. Regression analysis of longitudinal survey data representative of the general population was used to isolate the effects of increased government health expenditure on morbidity-related, QALY gains. Clinical judgement informed the duration of health-related quality-of-life improvement from the annual increase in government health expenditure. Results: The base-case reference ICER was estimated at AUD28,033 per QALY gained. Parametric uncertainty associated with the estimation of mortality- and morbidity-related QALYs generated a 95% confidence interval AUD20,758–37,667. Conclusion: Recent public summary documents suggest new technologies with ICERs above AUD40,000 per QALY gained are recommended for public funding. The empirical reference ICER reported in this article suggests more QALYs could be gained if resources were allocated to other forms of health spending.
Keywords: Humans
Regression Analysis
Least-Squares Analysis
Decision Making
Quality-Adjusted Life Years
Quality of Life
Biomedical Technology
Cost-Benefit Analysis
Health Expenditures
Financing, Government
Technology Assessment, Biomedical
Delivery of Health Care
Rights: © Springer International Publishing AG 2017
DOI: 10.1007/s40273-017-0585-2
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