Abstract
Introduction: There has been lots of debate regarding an appropriate value of cost- effectiveness threshold around the world. Many countries including United Kingdom and Thailand receive request that the current CET is too low and should be increased. To our knowledge, Thailand is the only country which has explicit CET and has increased the CET. Therefore, Thailand is in a unique position to help answer the question of what happened when CET was increased. The findings from this study can assist in the discussion of whether CET values should be increased. Health Intervention and Technology Assessment Program (HITAP) was commissioned by the National Drug Subcommittee to answer the question of “What are the Impacts of Increasing Cost-effectiveness Threshold?” to assist in the discussion of whether or not Thailand’s current CET should be increased. Objectives: This study examined the impact of increasing CETs on the medicine prices submitted by pharmaceutical companies in economic evaluation reports to the Thailand National List of Essential Medicines (NLEM) subcommittee, the decision to include or exclude new medications in the NLEM of the Thai government, and budget impact under universal health coverage. Methods: This study started with a review of relevant documents and literature. Subsequently, we conducted a secondary data analysis using data obtained from economic evaluation reports from the National List of Essential Medicines between 2008 and 2020. Multivariable regression model were used to analyze the effects of CET on yearly drug price and the decision to select drugs to be included in the National List of Essential Medicines. Given the available data, descriptive analysis was used to explore the budget impact of included drugs. Results: The study found that increasing CET did not have a statistically significant impact on both the yearly drug cost and the chance of drugs being included into NLEM. There were other factors which may influence yearly drug cost and the chance of drugs being included into NLEM. The available budget data cannot answer the research question of whether or not increased CET can affect the budget burden of the health insurance system. Conclusions: The current findings could not support whether or not the current CET value in Thailand should be increased. Furthermore, future research should continue to monitor the situation and reanalyze the current work as more data become available (as insignificant findings may be due to small sample size). Additionally, qualitative research should be supported to understand the context and provide an in-depth explanation of the phenomena found in this quantitative study.
