Establishing multiple cost-effectiveness thresholds in Oman: a stakeholder-driven approach.

Abstract

The rising cost of new health technologies and limited healthcare budgets challenge health systems worldwide, including Oman. Local value judgments are crucial for informed decision-making. This study aims to establish a cost-effectiveness thresholds (CETs) framework for Oman, aligned with the country's economic status and healthcare priorities. The key findings from a recent literature review on global CETs and their applications were shared and discussed during a multi-stakeholder workshop in March 2024. Presenting these findings has provided participants a broad understanding of global CET practices and highlighted the use of multiple thresholds across different settings. Afterwards, a survey was distributed, asking participants to anonymously vote on six key concepts: the basis for the threshold, the baseline threshold multiplier, the use of multiple thresholds, the criteria for multiple thresholds, the number of multipliers, and which criterion should receive the 3X multiplier. The results from this voting guided the design and final agreement on the threshold values. Twenty respondents supported adopting multiple CET values based on cost per quality-adjusted life-year (QALY), linked to Oman's economic status. A baseline CET equal to 1x Gross Domestic Product (GDP) per capita was suggested. Participants recommended three different threshold multipliers to reflect policy priorities. A continuous multiplier (1-3x GDP), based on incremental QALY gains, was used to favor technologies with greater health gains. Additionally, a fixed multiplier of 2 was chosen for both orphan drugs and treatments for priority diseases. The resulting CET values reflect technical and expert consensus and do not include patient or public perspectives. In Oman, the incremental cost per QALY gained should not exceed 1x GDP per capita for new health technologies that offer minimal health gains in common diseases. However, thresholds might increase to 12x GDP per capita for curative treatments in rare priority disease areas. It is recommended that CET values be reviewed and updated within three years, based on initial implementation experiences.