Optimal Cost-Effectiveness Threshold Value Versus Socially-Desired Threshold Value: Proposing a Multiple Threshold Value Model

In the context of the threshold value, setting priorities solely on the basis of cost-effectiveness can lead to socially undesirable decisions. An implicit adherence to the threshold value concept causes asymmetries in both health policy and society in general. Purpose: In this study, a multiple threshold value model will be developed which will represent an optimization model that is not exclusively based on the criterion of cost-effectiveness, but also incorporates additional decision criteria. Methods: First, due to the deficiency of the German goal-oriented healthcare system, criteria will be presented which could be relevant, in addition to cost-effectiveness, for the reimbursement of healthcare expenses. Furthermore, in order to determine a concrete monetary value for a medical outcome, it is necessary to identify the (optimal) health budget. Results: It is shown that the cost-effectiveness criterion is compatible with other equity specific criteria. As a result, a multiple threshold value model is developed, which, in addition to cost-effectiveness, acknowledges evidence-based medicine and the existence of alternative medicine treatments. Conclusion: For a rational allocation of resources, the multiple threshold value model is an enrichment that considers cost-effectiveness and, in particular, medically reasonable and equitable treatment methods in quantifiable forms. It seems advisable to initially concentrate on selected fields of medical care, which means a partial implementation of the multiple threshold value model. Further adjustments and amendments are not only possible, but desirable.