In economic evaluation, thresholds provide a reference point. But real decisions also depend on uncertainty, budget impact, equity, medical need, and adoption conditions.
A threshold is a reference point, not a decision
A cost-effectiveness threshold helps interpret an incremental cost-effectiveness ratio. It places an intervention relative to an implicit or explicit willingness to pay for a health gain.
But it should not be used mechanically. An intervention below a threshold may remain difficult to fund, while one above it may still be discussed if medical need, equity, or uncertainty justify consideration.
The ICER depends heavily on context
The result depends on the comparator, perspective, time horizon, included costs, utility data, and modeling assumptions.
A serious interpretation of thresholds therefore requires understanding how the ICER was produced and which variables shape the result.
Uncertainty should accompany interpretation
A probability of cost-effectiveness, acceptability curve, or scenario analysis helps show whether the conclusion is stable or fragile.
This information is often as important as the central ratio because it indicates the level of confidence that can be placed in the decision.
The threshold should be connected to opportunity cost
Behind any threshold lies a question of opportunity cost: what must be forgone, reduced, or delayed if a new intervention is funded? This question is central for health systems operating under budget constraints.
A meaningful threshold should therefore not be seen as an abstract monetary value. It should be connected to the system’s real capacity to fund one option without displacing other valuable interventions excessively.
Institutional context changes the decision
The same ICER value may be interpreted differently depending on the country, payer, disease severity, population rarity, available alternatives, and political priority of the therapeutic area.
This is why economic analysis should be accompanied by an institutional reading: who decides, under which constraints, according to which criteria, and for which health policy objective?
A more mature reading of value
Thresholds are useful when they support structured discussion about value. They become risky when they replace analysis.
Santicxis helps interpret cost-effectiveness results with nuance by connecting thresholds, uncertainty, budget impact, and institutional constraints.