Is France going to set an "acceptable" cost/QALY thresold ? No, but...

Things are moving in the field of medico-economic evaluation in France. First, at the beginning of that year the General Inspection of Sanitary Affairs (the IGAS) has issued a report entitled " Medico-economic evaluation in health" in which several recommendations are presented.



Regarding the possible determination of a theoretical fixed efficiency threshold, the IGAS considers this as an "utopia". According to the commission it would be very difficult to justify the use of such a fixed threshold in order to refuse any new product for which the cost/benefit ratio would be superior to that threshold. Nevertheless, in this report, the commission also indicates that when it comes to consider transportation investment dedicated to road safety (in order to save life and avoid disabilities, something finally very similar to health products objectives...) the cost of a life has been determined to be around 1,9 millions of euros, corresponding to a cost per year around 45 000 euros... Thus if such value can be used in the field of transportation investment, why couldn't it be used in the health sector...?



Then, almost at the same time, the HAS has issued a working document, based on literature review and entitled "Reference values for health economic evaluation". Amongst the 4 methods described to set reference values, the HAS evokes the determination of the statistical value of human life in regard of public investments. This value has been determined in a report issued by the "Commissariat general à la stratégie et à la prospective" as being of 3 millions of euros corresponding to a value per year of saved life of 115 000 euros. The authors of this report specify that, in order to apply that theoretical value to the Health sector, there would be a need to consider the quality of life in that value determination. Then, in its own report conclusions the HAS doesn't consider that determining such a statistical value is an "utopia"...


Nevertheless, even if both reports present different approaches regarding this notion, HAS and IGAS both agree on the fact that, before considering what an acceptable cost/QALY should be, there is first an urgent need for budgetary impact to be assessed. It is in fact a strong request from authorities (and especially from the CEESP) to see budgetary impact models presented in medico-economic dossiers as a cost/QALY doesn't give any indication of the overall expenditures linked to a new drug introduction. This drug can in fact be associated with a low cost/QALY but also with a major budget impact if this drug is to be prescribed to a large patient population.


 


Finally, it is amazing to see that something ("what's the cost of a life ?") that used to be a "taboo subject" for many years in France is now considered as one of the possible elements that might be taken into account to set reference values for health economic evaluations...



Bruno FRANCE