Estimating a cost-effectiveness threshold for healthcare decision-making in the Greek NHS

Background: The introduction of new health technologies improves quality of life and longevity, but also imposes additional strains in the scarce resources of the health system. Consequently, decisions on the adoption of new technologies are typically based, among other criteria, on the difference between costs and outcomes among competing alternatives. This paper aims to estimate a cost-effectiveness threshold that can be used as an input in the decision-making process for the funding (or reimbursement) of health technologies in Greece. Methods: For a 30-year period, we calculate the Quality-Adjusted Life Expectancy (QALE) of the Greek population and regress it against per capita public health expenditure, using an instrumental variable approach and controlling for a set of covariates. The estimated coefficients of expenditure on QALE are used to inform a cost-effectiveness threshold, estimatead as the cost per QALY gained through a permanent increase in per capita spending. Results: Based on the estimated coefficient of health expenditure, we estimate a base case cost-effectiveness threshold of €27,117 per QALY gained for the Greek healthcare system, from a third-party payer perspective. Conclusions: In the Greek healthcare system, which is currently in the stage of establishing a comprehensive health technology assessment process, decision rules which are not based on heuristics or “rules of thumb”, are essential.