An article published in this Journal argued that New Zealand does not apply a cost-effectiveness threshold because medicines are funded within a fixed budget and because cost-effectiveness is only one of nine criteria that inform decisions. This Comment has explained that, from a theoretical perspective, the cost-effectiveness threshold model is not inconsistent with these two arguments. The observed annual variation in incremental cost-effectiveness ratios in New Zealand may originate from yearly differences in new medicines that request reimbursement and in the budget size, and from the fact that decision makers take into account other decision criteria in addition to cost-effectiveness.
Keywords: cost-effectiveness; cost-effectiveness threshold; decision criteria; economic evaluation; health economics; multi-criteria decision analysis; opportunity cost.