Headroom Beyond the Quality- Adjusted Life-Year: The Case of Complex Pediatric Neurology

Abstract

The headroom method seems a useful tool in the very early evaluation of medical technologies, also in cases when immediate QALY gain is unlikely. It allows for allocating healthcare resources to those technologies that are most promising. It should be kept in mind, however, that the headroom assumes an optimistic scenario, and for that reason cannot guarantee future cost-effectiveness. It might be most useful for ruling out those technologies that are unlikely to be cost-effective.

Methods for Early Assessment of the Societal Value of Health Technologies: A Scoping Review and Proposal for Classification

“…23 This gap may be expressed in qualityadjusted life-years, but other metrics can be considered when duration or quality of life are not the most relevant outcomes. 24,25 The outcomes of either of these modeling methods serve as input for additional stakeholder involvement to complete the problem assessment. Stakeholders may reflect on any inconsistencies between their experience and the evidence-based model of current practice, help distinguish issues from nonissues, and can help interpret the magnitude of the quantified room for improvement.…”

A different animal? Identifying the features of health technology assessment for developers of medical technologies

“…Developers have the option to offer their technology (subject to local regulatory constraints) wherever the potential is greatest and to target patients and/or clinicians directly or to sell via national health services. For example, van Nimwegen et al (18) used parents' willingness to pay for a diagnosis to calculate “headroom” (valuing an estimated extension in life and/or improvement in quality of life at a given threshold value with an adjustment for the cost impact of the technology) rather than an explicit threshold for reimbursement as it was felt that the technology would be best suited to the private payer market. The business model adopted by the commercial developer or investor may differ across jurisdictions.…”

“…DF-HTA differs from other forms of HTA because of the requirements of its target audience. In published studies, the target audience is often not explicitly defined (e.g., [17][18][19]. In some cases, the analysts appear to adopt the perspective of a payer even when the HTA is undertaken to inform the developer.…”

Headroom Analysis for Early Economic Evaluation: A Systematic Review

“…The headroom analysis can be used for pricing policies and to feed into a return-on-investment calculation. As the headroom analysis cannot guarantee future cost effectiveness, it is most useful for ruling out health technologies that are unlikely to be cost effective in future [11]. The rigor of the headroom analysis depends on its aims, the stage of development, and resources available for assessment.…”