Cost-effectiveness and dynamic efficiency: does the solution lie within?

Abstract

The majority of the current systems spread across the world require the demonstration of the value of pharmaceuticals to be done with an acceptable degree of certainty before a technology is funded. Often involving the notion of cost-effectiveness, one of the key characteristic of such assessments tends to be the consideration of efficiency as a static outcome; with a strong emphasis on current health gains but a disregard of the impact of decision making on the potential health value over time. In this manuscript we argue that current systems using cost-effectiveness thresholds may provide an incomplete indicator of value and defend that funding decisions should be informed by dynamic efficiency considerations by considering both the current and the future value of achieving a certain level of effectiveness in a disease area. We further lay down the foundations for the implementation such framework.