Consistent defined threshold and equity in health

In measuring health, economic evaluations, the threshold is an important concept. It signifies the value of health gain and a new intervention is considered satisfactory if its price falls below a certain threshold [1].

Results are usually reported in an incremental cost-effectiveness ratio (ICER). The ICER stands for the additional costs per additional health unit produced by one intervention in comparison to another. A common tool for measurement is the quality-adjusted life-year (QALY). QALY encompasses both length and quality of life, which is based on utility. Likewise, various organizations and governmental bodies such as the National Institute for Health and Clinical Excellence (NICE) in the UK, Swedish Pricing and Reimbursement Board, the Pharmaceutical Benefits Advisory Committee in Australia, Dutch Health Care Insurance Board (CVZ) in The Netherlands have adopted certain threshold values. This adoption of threshold optimizes the process of allocation of health care resources [2].

Reimbursement decisions and allocation of health care resources is evolving in developing nations. Though cost-effectiveness analysis is increasingly being used for reimbursement mechanisms in developing countries, however, there is no consistent defined threshold. Most developing countries have adopted one to three times of their local gross domestic product (GDP) per capita as a threshold. This is also recommended by the World Health Organization (WHO). However, it is argued that the range of 1 to 3 folds is a wide range and hence it is imperative to evaluate the exact QALY threshold especially with regards to public preferences