Fig. 4.

The impact of including broader elements of value on the incremental cost-effectiveness ratio. Source: Modified from Ito et al. [45]. Ito and colleagues estimated the cost-effectiveness of a hypothetical treatment for Alzheimer’s disease that delays progression to dementia for patients with mild cognitive impairment [45]. The ICER varied depending on whether the model included factors beyond a patient’s own health. When caregiver costs (e.g., caregiver time caring for the patient or work lost by taking care of the patient) and caregiver quality-of-life effects were included, the cost-effectiveness of the hypothetical Alzheimer’s treatment improved substantially, from $183,000 per QALY gained to $74,000 per QALY gained—a 60% decrease in the cost-effectiveness ratio. At a decision threshold of US $150,000 per QALY gained, this study demonstrated that failing to consider important value elements from a societal perspective can underestimate the value of novel medicines, impact coverage and reimbursement, limit access, and reduce the welfare of patients [46]