Background
Cost-effectiveness analyses provide meaningful insights to policy decisions only when their results are compared against a benchmark threshold. The Cost-Effectiveness Threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain โ typically one Quality-Adjusted Life Year (QALY). Without a clear national CET, reimbursement and pricing decisions risk being inconsistent or economically unsound.
A global review of CETs shows that the average threshold expressed as a percentage of GDP per capita across all countries is approximately 135%, ranging from 21% to 300%. Higher-income countries tend to apply a lower CET relative to their GDP per capita, while lower-income countries apply higher relative thresholds โ a pattern that informed the Egyptian framework.
Egypt’s National CET Framework
Through a structured process combining a systematic literature review and a multistakeholder consensus workshop โ including representatives from the Egyptian Authority for Unified Procurement (EAUPMT), the Universal Health Insurance Authority (UHIA), the Egyptian Drug Authority (EDA), the World Health Organization (WHO), and academic institutions โ Egypt established its national CET framework.
The consensus recommends a variable threshold of 1 to 3 times GDP per capita, determined by the Incremental Relative QALY Gain (IRQG): the greater the relative health gain a new technology delivers over its comparator, the higher the threshold applied. For orphan medicines, an additional multiplier of 1.0 to 3.0 is applied, reflecting disease rarity, severity, clinical evidence quality, patient age, budget impact, and societal burden. A two-times multiplier was adopted for private-sector reimbursement compared to public-sector reimbursement.
How the Calculator Works
This tool operationalises Egypt’s CET framework in three steps. First, the IRQG is computed from the undiscounted QALYs of the new intervention and the comparator, and mapped to the corresponding multiplier (1×, 2×, 2.5×, or 3× GDP per capita). Second, if the intervention is an orphan drug, six weighted criteria are scored to produce the Orphan Multiplier โ ranging from 1.0 (poorest profile) to 3.0 (strongest profile). Finally, the Public CET and Private CET are calculated and compared against the ICER to determine cost-effectiveness in each setting.
Reference
Fasseeh, A.N., Korra, N., Elezbawy, B., Sedrak, A.S., Gamal, M., Eldessouki, R., Eldebeiky, M., George, M., Seyam, A., Abourawash, A., Khalifa, A.Y., Shaheen, M., Abaza, S., & Kaló, Z. (2024). Framework for developing cost-effectiveness analysis threshold: the case of Egypt. Journal of the Egyptian Public Health Association, 99(1), 12.
IRQG Formula
* The IRQG should be calculated based on undiscounted QALYs
IRQG Multiplier Table
| Incremental Relative QALYs Gain (IRQG) | CET Multiplier |
|---|---|
| 0.00 – 0.10 | 1.0 × GDP per capita |
| 0.10 – 0.25 | 2.0 × GDP per capita |
| 0.25 – 0.50 | 2.5 × GDP per capita |
| 0.50 – 1.00 | 3.0 × GDP per capita |
Orphan Multi-Criteria Scoring Weights
| Criterion | Weight | Score Range |
|---|---|---|
| Severity of the condition | 38.64% | 0% – 100% |
| Rarity of the disease | 24.15% | 0% – 100% |
| Budget Impact | 16.10% | 0% – 100% |
| Credibility of clinical evidence | 10.16% | 0% – 100% |
| Average age of patients | 6.39% | 0% – 100% |
| Societal impact of treatment | 4.56% | 0% – 100% |
| Total | 100% | Max weighted score = 1.0 |
Orphan Score = Σ(weighti × score%i) → ranges from 0.0 to 1.0
Orphan Multiplier = (2 × Orphan Score) + 1 → ranges from 1.0 (worst) to 3.0 (best)
CET Formula
| Setting | Formula |
|---|---|
| Non-Orphan (Public) | IRQG_Mult × GDP(EGP) |
| Orphan (Public) | IRQG_Mult × GDP(EGP) × Orphan_Mult |
| Private (any) | CET_Public × 2 |
Country Parameters — Live Data
GDP Source: IMF World Economic Outlook — GDP per Capita (NGDPDPC) (fallback: World Bank) · Exchange Rate: World Bank — PA.NUS.FCRF
Economic Parameters
Override values manually
Source: World Bank NY.GDP.PCAP.CD
Source: World Bank PA.NUS.FCRF