Economic evaluation
Type 2 diabetes: cost-effectiveness evaluation of a new treatment
Context: A ministry of health needs to assess whether a new antidiabetic treatment should enter the reimbursed basket of care despite high cost, budget pressure, and uncertainty around real value.
Objective: Determine whether the treatment is cost-effective, budget-sustainable, and defensible for reimbursement.
Methodology:- Markov model with a lifetime horizon
- Health system perspective
- 3% discounting
- Health states: no complications, micro and macrovascular complications, death
- Parameters drawn from literature, local data, and clinical studies
Results:- QALY gain: +0.85
- Incremental cost: +$1,020
- ICER: $1,200 per QALY
- Probability of cost-effectiveness: 78% at a $3,000 per QALY threshold
Conclusion: The treatment emerges as cost-effective, sustainable, and recommended for adoption.
Decision impact:- Strong scientific justification for decision-makers
- Direct support for public decision-making
- Better resource allocation
Market access
Oncology: economic evaluation of an innovative treatment
Context: A health authority must rule on the reimbursement of a targeted therapy in a context of high price, high clinical stakes, and strong uncertainty around survival.
Objective: Assess the treatment’s economic value and document the impact of survival assumptions, pricing, and population targeting.
Methodology:- HTA-oriented oncology modeling over a 10-year horizon
- Primary inputs from clinical trials
- Uncertainty analysis on survival and scenario variability
- Scenario testing on price reductions and patient targeting
Results:- QALY gain: +1.2
- Incremental cost: +$18,000
- ICER: $15,000 per QALY
- Reduced price scenario: ICER lowered to $9,000
Conclusion: The dossier shows defensible value potential, but one that remains sensitive to price and survival assumptions.
Decision impact:- Clarifies reimbursement conditions
- Provides an objective basis for price negotiation
- Supports better patient targeting to improve efficiency
Public health
Vaccination: evaluation of a national public health program
Context: A resource-constrained country is considering the introduction of a new vaccine and must balance upfront cost, population impact, and program sustainability.
Objective: Evaluate cost-effectiveness, population impact, and the financial sustainability of a national vaccination program.
Methodology:- Simplified dynamic model
- 20-year analytical horizon
- Public-health-oriented approach focused on population effects
Results:- Incidence reduction: -35%
- Hospitalization reduction: -50%
- ICER: dominant with net savings
Conclusion: The program emerges as highly cost-effective and recommended for national implementation.
Decision impact:- Improves population health
- Reduces hospital costs
- Provides a strong case for funders and financing partners
Reimbursement
Rare diseases: reimbursement strategy for a specialized therapy
Context: A manufacturer was preparing the positioning of a therapy intended for a small population, with a high unit cost and promising but still limited clinical data. The challenge was to build a sufficiently robust dossier to reassure payers despite residual uncertainty.
Objective: Define a credible reimbursement strategy combining clinical value, economic value, and progressive adoption conditions.
Methodology:- Critical review of available clinical evidence and identification of major uncertainty areas
- Development of a value argument focused on incremental clinical benefit
- Pricing, patient targeting, and phased adoption scenarios
- Qualitative assessment of institutional acceptability conditions
Results:- Three reimbursement scenarios prioritized according to acceptable risk level
- Clarification of minimum targeting conditions to improve efficiency
- Value narrative refocused on patients with the highest expected benefit
- Reduced rejection risk linked to a request perceived as premature
Conclusion: The dossier was repositioned around a phased reimbursement logic, better aligned with payer risk tolerance.
Decision impact:- Stronger dossier credibility with authorities and payers
- Better control of the price-versus-uncertainty discussion
- Greater ability to negotiate on structured and defensible grounds
Health policy
Budget prioritization: arbitrating across multiple health interventions
Context: A public institution had to allocate limited resources across several competing interventions, all considered useful but impossible to fund simultaneously at the same level. The need was for a credible prioritization method, readable for decision-makers and publicly defensible.
Objective: Build an arbitration framework capable of comparing options according to impact, cost, equity, and feasibility.
Methodology:- Multi-criteria matrix combining health impact, cost, operational feasibility, and equity
- Scoping workshops with institutional stakeholders
- Funding scenarios under differentiated budget envelopes
- Translation of results into concrete decision options
Results:- Clear ranking of interventions across three priority levels
- Identification of programs to maintain, expand, or phase
- Improved visibility on trade-offs between equity and efficiency
- Shared discussion basis across technical, financial, and governance actors
Conclusion: The prioritization exercise turned a sensitive budget constraint into a structured, argued, and institutionally sustainable decision.
Decision impact:- Better internal acceptance of budget decisions
- Improved traceability of arbitration criteria
- Reduced risk of decisions being perceived as arbitrary
Institutional capability
Capacity building: structuring an in-house health economics unit
Context: An organization wanted to reduce its dependence on external expertise and build internal capability able to read, challenge, and gradually produce economic analyses useful for decision-making.
Objective: Design a realistic capability-building pathway combining training, governance, methods, and deployment priorities.
Methodology:- Diagnostic of analytical maturity and priority needs
- Mapping of critical capabilities in health economics and HTA
- Progressive training pathway for decision-makers, analysts, and management
- Recommendations on organization, governance, and operational roadmaps
Results:- Definition of a three-phase roadmap for capability scaling
- Clarification of roles between internal expertise, external support, and governance
- Prioritization of early high-value demonstrator deliverables
- Creation of a shared language between technical teams and decision-makers
Conclusion: The organization moved from a broad capacity-building ambition to a concrete, progressive, and operational structuring plan.
Decision impact:- Greater autonomy in reading and using economic evidence
- More credible and better sequenced capability-building
- Improved durability of investments in training and technical assistance
