Personalized_Medicine_A_New_Medical_and_Social_Challenge

v*Δh

Δch

k



Δcc> 0 ð 1 Þ

whereΔhdenotes the patient’s incremental QALY gain andΔchdenotes the
incremental costs falling on the health care budget. In Eq. ( 1 ),krepresents the
opportunity cost of displacing one unit of health elsewhere in the health care system
or, alternatively, a reciprocal of a shadow price of the budget constraint. It can be
seen as the correction factor for health care costs, intended to ensure a true
reflection of opportunity costs within a fixed (and, in a conventional economic
sense, nonoptimal) health care budget.Δccdenotes the net consumption cost of an
intervention, which, if positive, indicates net consumption losses to the wider
economy and, if negative, indicates net consumption benefits to the wider economy.
The sign will depend on aspects like the treated patient population, the intervention
under study, and the illness it is aimed at. Finally,vis a monetary valuation of
health, representing the rate at which the society is willing to trade health and
consumption and can be seen as the appropriate threshold to be used to judge the
ICERs of interventions in a societal welfare assessment.^16
Although the correction factorkhas also been labeled as the cost-effectiveness
threshold, for instance in Claxton et al. ( 2010 ), for simplicity reasons we here
assume thatvis equal tok(i.e., that the budget is flexible, set optimally and the cost-
effectiveness of marginal spending in the health care sector equals the societal
value placed on a gained QALY), and by rearranging Eq. ( 1 ), we obtain the
appropriate decision rule for CUA:

Δch þΔcc

Δh

<v ð 2 Þ

Equation ( 2 ) indicates that an intervention is cost-effective, or welfare improving,
when the incremental costs incurred to produce incremental health benefits do not
exceed the social value of health. Social value of a health gain constitutes an
explicit threshold for acceptability, reflecting the consumption value a society
places on marginal health gains, i.e., the monetary value society is willing to pay
(or the consumption it is willing to forego) to obtain an extra unit of health
(a QALY).^17 Explicit thresholds are being considered in different health care
systems. The main health care decision-making body in the Netherlands College
van Zorgverzekeringen (CVZ) proposed in 2009 an explicit range of threshold
values ranging from€10,000 per QALY gain for diseases with a low severity status
to€80,000 per QALY achieved in diseases with a high severity status, and this size
of the threshold is being also empirically tested.^18

(^16) Further details available in Bobinac ( 2012 ).
(^17) For further discussion on the monetary value of health gains, see Bobinac ( 2012 ).
(^18) Examples of empirical studies are Bobinac et al. ( 2013 ), pp. 1272–1281; and Bobinac
et al. ( 2014 ), pp. 75–86.
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