Population-level assessment of healthcare cost-effectiveness from the payer's perspective in the Czech Republic: methodology and threshold setting using administrative data.

OBJECTIVE

The aim of this study was to propose a methodology for assessing the cost-effectiveness of healthcare services at the population level and to establish a corresponding cost-effectiveness threshold from the payer's perspective, taking into account economic sustainability and the data available to the payer.

MATERIALS AND

METHODS

Analysis was based on data from a Czech health insurance fund covering the period 2014-2024. A binary health status metric, Health Services Derived Disability (HSDD), was developed and calibrated against the Healthy Life Years (HLY) indicator. Subsequently, two cost-effectiveness threshold values were derived from real-world data on healthcare expenditures, mortality, and HSDD: CETLY (Cost-Effectiveness Threshold per Life Year) and CETDFLY (Cost-Effectiveness Threshold per Disability-Free Life Year). Cost-effectiveness can be evaluated using both thresholds within a net monetary benefit framework.

RESULTS

CETLY was derived from expenditures in the 0-69 age group, while the calculation of CETDFLY excluded individuals who died in a given year to avoid distortion from high end-of-life costs. For the year 2024, CETLY was estimated at 465,500 CZK (20,056 USD; 35,918 USD adjusted for PPP), and CETDFLY at 96,600 CZK (4,162 USD; 7,454 USD adjusted for PPP). In nominal terms, the year-on-year increase in CETLY was approximately 7.9%, and in CETDFLY approximately 6.5%.

LIMITATIONS: The methodology does not account for the subjective dimension of quality of life and may underestimate certain types of disability. HSDD is a binary indicator that does not reflect severity levels. The transferability of the methodology to other healthcare systems depends on the equity of access to health care and the availability of administrative data.

CONCLUSION

The proposed methodology enables continuous assessment of the cost-effectiveness of healthcare services at the population level using administrative data. It can serve as a supporting tool for payers in the evaluation, and optimization of healthcare programs and interventions.