Use of Cost-Effectiveness Thresholds in Healthcare Public Policy: Progress and Challenges.

The article offers a comparative analysis of the influence of cost-effectiveness thresholds in the decision-making processes in financing policies, coverage, and price regulation of health technologies in nine countries. We investigated whether countries used cost-effectiveness thresholds for public health policy decision making and found that few countries have adopted the cost-effectiveness threshold as an official criterion for financing, reimbursement, or pricing. However, in countries where it is applied, such as Thailand, the results have been very favorable in terms of minimizing health technology prices and ensuring the financial sustainability of the health system. Although the cost-effectiveness threshold has opportunities for improvement, particularly in certain institutional contexts and with adequate participation of the different strategic actors in the formulation of public policy, its potential use and added value are significant in various aspects.

Estimating cost-effectiveness thresholds under a managed healthcare system: experiences from Colombia.

Like most of the world, low- and middle-income countries have faced a growing demand for new health technologies and higher budget constraints. It is necessary to have technical instruments to make decisions based on real-world evidence that allows maximization of the population's health with a limited budget. We estimated the supply-based cost-effectiveness elasticity, which was then used to determine the cost-effectiveness threshold for the healthcare system of Colombia, a middle-income country where multiple insurers, paid under capitation rules, manage the compulsory contributions of the citizens and government subsidies. Using administrative data, we explored the variation of health expenditures and outcomes at the insurer, geographical region, diagnosis group and year levels. To deal with endogeneity in a two-way fixed-effects model, we instrumented health expenditures using characteristics of the health system such as drug-price regulation. We estimated the threshold to be US$4487.5 per years of life lost avoided [14.7 million Colombian pesos (COP) at 2019 prices] and US$5180.8 per quality-adjusted life-years gained (17 million COP at 2019 prices), around one times the gross domestic product GDP per capita. To the best of our knowledge, this is the first estimation of the cost-effectiveness threshold elasticity supply-based in a middle-income country with a managed healthcare system.

Condiciones de trabajo y salud del personal docente administrativo y de servicio del Instituto Nacional Mejía Quito-Ecuador / Condition of work and health of the administrative educational personnel and of service of the National Institute Mejía Quito-Ecuador

La investigación social ralizada permite conocer las condiciones de vida y trabajo y proceso salud-enfermedad de docentes, personal administrativo y de servicios de una institución educativa fiscal de educación media, El Instituto Nacional Mejía (INM), durante el año lectivo 1993-1994; se utiliza un diseño transversal con corte de período, en el cual la exploración mediante exámenes de laboratorio, encuesta individual (en una muestra representativa con el 95 por ciento de confianza: docentes n= 133, administrativos n=53, servicios n=30), nos proporcionan datos de prevalencia; por otro lado se completa el estudio con una exploración sensorial del sitio de trabajo aplicando una variante del Modelo Obrero Italiano