From HTA results to guidance implementation: paving the way

  • Identify and categorise technologies offering prospects for efficiency gains outside incremental innovations (higher quality/higher costs)

  • Clarify under which conditions decremental cost-effectiveness is acceptable for collective health gains

  • Develop a tool-box for use at a local level for HTA projects to maximise those health gains

  • Systematic search of clinical trials registries and published literature to identify decrementally cost-effective programmes, as for example non-drug interventions or non-inferiority trials

  • Conduct a systematic enquiry into the willingness of stakeholders (namely patients, professionals, decision makers, tax payers) to accept a decremental efficacy

  • A toolbox and guidance for HTA agencies to go beyond cost-effective comparators in their assessments and recommendations

  • The algorithm used to identify the decrementally cost effective programmes will be published as well as a state of art analysis in Europe of candidate technologies

  • An analysis of the obstacles and potential drivers for acceptance of decremental efficacy using a political economy approach of stakeholders’ perspectives

  • The toolbox will provide specific methodological and policy guidance concerning the evaluation and implementation of candidate technologies 


  • November 2019 – Budget impact analysis of triple therapy after failure of methotrexate for the treatment of rheumatoid arthritis in France – ISPOR Europe [weblink]

  • November 2019 – Annual cost of patients undergoing a total knee replacement in France – ISPOR Europe [weblink]

  • Toolbox on candidate cost-effective technologies for HTA producers and users [PDF]

  • Systematic review of decrementally cost-effective interventions [PDF]

  • Work Package Overall Results [Poster PDF]


Paris School of Economics – Hospinnomics


Assistance Publique-Hôpitaux de Paris

Principal Investigators

Lise Rochaix

Isabelle Durand-Zaleski