Minimally important difference in health gain valuation.

Abstract

Minimal important difference (MID) thresholds distinguish noticeable from meaningful health gains, yet reimbursement decisions often fund high-cost therapies with marginal benefit. Clarifying meaningful patient-reported improvement is important for interpreting evidence and allocating resources. We reviewed how MID concepts are defined and used across outcomes research, clinical trials and health technology assessment (HTA), and estimated Croatia's first EuroQol Visual Analogue Scale (EQ-VAS) MID in a representative sample (n = 401), examining whether thresholds vary by baseline health and a €100/month co-payment. Respondents stated the smallest noticeable and meaningful EQ-VAS improvement for a free intervention and the same intervention requiring a co-payment for one year. Analyses combined descriptive statistics, rank-based tests and multivariable regression. Mean MID was 7.9 EQ-VAS points when treatment was free and increased to 8.7 with co-payment, with higher thresholds among those with poorer baseline health. The co-payment scenario is interpreted cautiously as reflecting a worthwhile-improvement threshold rather than a pure intrinsic MID. Elicited thresholds were context-sensitive; however, the co-payment scenario captures what respondents considered worth paying for, arguing against universal MID cutoffs. In HTA, MIDs should serve as patient-centered interpretive benchmarks complementing cost-effectiveness evidence and considerations such as equity and societal preferences.