Comparative study on economic evaluation applied to decision ‑making in seven countries: implications for the Japanese healthcare system

Abstract

There are established methodological frameworks for economic evaluation, but because healthcare systems are different among countries and have long histories, economic evaluation has to evolve and adapt to the current healthcare system or situation in each country. We surveyed health technology assessment organizations and studied the application of economic evaluation to decision-making in seven countries that utilize economic evaluation in their healthcare systems（the United Kingdom, Sweden, the Netherlands, Canada, Australia, Korea, and Thailand）. We used a common questionnaire for semi-structured interviews in every country. In these seven countries, the healthcare system is tax-based in some countries and funded by social insurance fees in others. Many countries use economic evaluation for reimbursement decision-making. While many countries target all drugs or all innovative drugs for evaluation, the United Kingdom and Thailand only evaluate selected drugs. Some countries are re-evaluating listed drugs. In many countries, reimbursement of expensive anti-cancer drugs （such as sunitinib） and drugs influential on the budget （such as long-acting insulin） is restricted. Although the experiences in countries already using economic evaluation cannot be applied directly to other countries, comparison of their challenges is valuable for countries considering the use of economic evaluation.