Although the principles of cost-effectiveness analysis have been adopted by health systems worldwide, a large majority of countries remain reluctant to specify explicit threshold values for cost-effectiveness. Nonetheless, by aiming to benchmark what counts as a reasonable ‘price’ for health gains, the threshold value is a linchpin in the framework of health technology assessment, albeit also a controversial one. The desirability of thresholds depends largely on three claims: their intention to make resource allocation more efficient, their aspiration to make decision-making more transparent and their objective to make healthcare systems more sustainable. In this paper, we draw from various disciplines such as health economics but also psychology, anthropology, sociology, political sciences and ethics to discuss the many facets of these three values, related to the threshold debate. We discuss issues of allocative efficiency, fair decision-making, realpolitik, taboos, institutional justice and the rule of rescue. Based upon these considerations, which together substantiate the precautionary principle, we conclude that the case against thresholds is stronger than the case in favor and that most countries are right to be reluctant to use explicit threshold values.

中文翻译：

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卫生保健中明确的成本效益阈值：万花筒

尽管成本效益分析的原则已被全世界的卫生系统所采用，但大多数国家仍然不愿为成本效益指定明确的阈值。尽管如此，通过以基准衡量哪些是获取健康的合理“价格”为基准，该阈值是卫生技术评估框架中的关键，尽管也是有争议的。阈值的可取性在很大程度上取决于以下三个方面：提高资源分配效率的意图，提高决策透明度的愿望以及提高医疗体系可持续性的目标。在本文中，我们从健康经济学，心理学，人类学，社会学，政治科学和伦理学讨论了这三个价值观的许多方面，涉及到门槛辩论。我们讨论分配效率，公平决策，现实政治，禁忌，制度正义和救助规则等问题。基于这些考虑因素，它们一起证明了预防原则，我们得出结论，反对门槛的案子胜于赞成门槛的案子，而且大多数国家都有权不愿使用明确的门槛值。