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Over the years, cost-effectiveness has gained a more prominent role in the reimbursement decision process for new technologies. While considerable effort has been put into improving estimates of cost effectiveness ratios, we are left with limited grounds to come to a societal decision on whether a cost-effectiveness ratio is acceptable or ‘too high’.
Traditionally, threshold levels of cost effectiveness have been derived from willingness-to-pay (WTP) studies. More recently, it has been argued that threshold levels of cost effectiveness may also be obtained by estimating the marginal returns to health care using health spending data linked to health outcomes. In this talk I will present theory underlying cost effectiveness threshold levels and discuss empirical estimates based on the marginal returns to medical care in the Netherlands.