OBJECTIVES: Cost-effectiveness thresholds (CETs) enable consistent reimbursement decision making, ensuring cost-effective healthcare innovations. This study aimed to map current practices in determining CETs, the variation in values, and the usage and interpretation of CETs in countries that use them in routine decision-making.

METHODS: A scoping review of scientific literature from 2015 to September 2023 was conducted to identify method for determining CETs and country-specific practices. Only English language publications were included, with searches conducted in MedLine, Embase, and Web of Science Core Collection.

RESULTS: Out of 3,494 publications, 47 were found to be eligible for inclusion. Three main approaches for estimating CETs were identified: demand-side, supply-side, and GDP per capita. The demand-side approach values health gains based on societal willingness to pay, while the supply-side approach maximizes health benefits within budget constraints by considering opportunity costs. Literature suggests combining these approaches by setting a base CET with the supply-side method, varying based on population preferences or to include additional factors beyond the QALY. 19 countries were identified considering either an official or an unofficial CET in routine decision-making. Among these countries, variability was shown in how the CET was determined (2 supply-side, 3 demand-side, 8 GDP, 6 other), utilized, and interpreted. Current CET values based on GDP per capita, mostly in lower income countries, are possibly overestimated, as comparison of the ratio of CET value and GDP per capita, shows that these countries are willing to pay more for one additional QALY than other, mostly higher income, countries.

CONCLUSIONS: This review highlights the lack of consensus on CET determination methods, variations in methodology and interpretation, and the potential overestimation of CET values contributing to inefficient healthcare resource allocation. Adapting existing approaches to consider national requirements, societal preferences, and economic factors may be needed for more accurate CET determination.