Impact of country-specific EQ-5D-3L tariffs on the economic value of systemic therapies used in the treatment of metastatic XXXX .

@entity788 @entity24882 @entity416 @entity5 @entity136
BACKGROUND: Previous Canadian cost-effectiveness analyses in @entity5 based on the EQ-5D-3L (EuroQoL, Rotterdam, Netherlands) have commonly used U.K. or U.S. tariffs because the Canadian equivalent only just recently became available. The implications of using non-Canadian tariffs to inform decision-making are unclear. We aimed to reevaluate an earlier cost-effectiveness analysis of therapies for metastatic @entity788 (originally performed using U.S. tariffs) with tariffs from Canada and various other countries to determine the impact of using non-country-specific tariffs. METHODS: We used tariffs from Canada, the United States, the United Kingdom, Denmark, France, Germany, Japan, the Netherlands, and Spain to derive EQ-5D-3L utilities for the 10 health states in the @entity788 model. Quality-adjusted life years (qalys) and @entity24882 ( @entity24882 ) were generated, and probabilistic sensitivity analyses (psas) were performed. RESULTS: Canadian utilities are generally lower than the corresponding U.S. utilities and higher than those for the United Kingdom. Compared with the Canadian-valued scenarios, U.S. and U.K. estimates were statistically different for 3 and 9 scenarios respectively. Overall, 35% of the non-Canadian utilities (28 of 80) were significantly different, clinically, from the Canadian values. Canadian qalys were 6% lower than those for the United States and 6% higher than those for the United Kingdom. When comparing the qalys of each treatment with those of @entity136 alone, the average percent change was +6.8% for a U.S. scenario and -7.5% for a U.K. scenario compared with a Canadian scenario. Consequently, Canadian @entity24882 were approximately 5.4% greater than those for the United States and 8.6% lower than those for the United Kingdom. Based on the psas and compared with the Canadian threshold value, the minimum willingness-to-pay threshold at which the combination chemotherapy regimen of @entity136 - @entity416 is the most cost-effective is  5,239 less than in the United States and  11,986 more than in the United Kingdom. CONCLUSIONS: The use of non-country-specific tariffs leads to significant differences in the derived utilities, @entity24882 , and psa results. Past Canadian EQ-5D-3L-based cost-effectiveness analyses and related funding decisions might need to be re-visited using Canadian tariffs.
