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However, the use of intraprocedural CEUS resulted in better cost-effectiveness compared with the standard procedure and a higher probability of being cost-effective, with a €5755 threshold of willingness to pay.
This ratio is well above a conventional threshold of willingness to pay of £20 000-30 000 per QALY.
There is some consensus about the threshold of willingness to pay for additional QALY internationally (e.g., $50,000 in the US, £30,000 in the UK, or AUS $42,000 in Australia) [ 34].
By adopting a conventional threshold of willingness to pay of £20 000-30 000 per quality adjusted life year (QALY), we found that structured psychological therapy is a cost effective treatment for mild to moderate postnatal depression, with an incremental cost effectiveness ratio (ICER) of £17 481 per QALY versus no treatment.
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However, in many cases an ICER may turn out to be less favorable or may approach or even exceed the threshold of willingness-to-pay.
In addition, value for money is explicitly addressed, and decision-makers can set their threshold of willingness-to-pay for innovation.
In the age group ≥80 years, the ICERs of QIV was below the threshold of willingness-to-pay in 7 years when QIV versus TIV cost level was + USD1.
As recommended by the World Health Organization (WHO), three-fold of gross domestic product (GDP) per capita was used as the threshold of willingness-to-pay per QALY [ 27].
Using 3-time GDP per capita (USD109,671) as the threshold of willingness-to-pay, ICERs of QIV indicated that it was more cost-effective than TIV for age group 65 79 years in 6 years when QIV cost USD1 more than TIV (Table 4).
This produced estimates of the probability that the intervention was cost-effective using several thresholds of willingness to pay for a QALY.
A cost-effectiveness acceptability curve was created to determine whether implementation of DCP was cost-effective given different thresholds of willingness to pay for QALYs (e.g., a threshold of €20,000 per QALY).
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