Table 1.

Comparison of health economic evaluation methods recommended in guidelines (China, UK, Canada, and Germany)

Methodological issue	China	UK	Canada	Germany
HTA agency	Not established	NICE	CADTH	IQWiG
Analysis method	CUA and CEA	CUA and CEA	CUA and CEA	CBA but also CUA and CEA (not standard practice)
Perspective	Healthcare system and societal	Payer (NHS) or societal if justified	Healthcare system and societal if justified	Usually statutory health insurance
Types of costs	Not explicitly specified	Direct medical, social services if justified	Direct medical	Depending on perspective: direct medical, and informal costs
Productivity loss	Recommended	Not recommended	Not recommended	Not necessary in base case. Consider if societal perspective
Preferred outcome measure	QALY	QALY (cost per life year gained, if CEA)	QALY	Medical outcomes
Utility score	Not available for many health conditions	Utility score from general population, by direct (eg, TTO, SG), indirect (EQ-5D), or systematic review	Utility score from general population, by direct (eg, TTO, SG), indirect (EQ-5D), or systematic review	Utility scores from patients, direct (eg, TTO, SG), indirect (specific PROM instruments)
WTP threshold	Not specified.	₤20,000-₤30 000 per QALY; empirically ₤12 936 per QALY	Not specified. CA$20 000, CA$50 000, and CA$100 000 are commonly used in research	Efficiency frontier (Institute’s own approach)
Cost-sharing level	High	No payment for both health care services and prescriptions	No payment for health care services. Pay the full cost of prescriptions if not covered by private insurance	No payment for health care services. Pay a small proportion of prescriptions costs (about 10%)

CADTH – Canadian Agency for Drugs and Technologies in Health, CUA – cost-utility analysis, CEA – cost-effectiveness analysis, CBA - cost-benefit analysis, HTA – health technology assessment. IQWiG – Institute for Quality and Efficiency in Health Care, NHS – National Health Service in UK, NICE – National Institute for Health and Care Excellence, PROM – patient-reported outcome measures, QALY – quality-adjusted life-year gained, SG – standard gamble, TTO – time trade-off, WTP – willingness-to-pay