A retrospective analysis of 68 Thai economic evaluations completed in 2010–2018 found negative net monetary benefit at the national threshold for 12 of 21 approved technologies. Every such approval documented non-cost-effectiveness considerations, showing that Thai reimbursement decisions use structured multi-criteria deliberation rather than cost-effectiveness alone.
Key findings
- Twelve of 21 approvals (57.1%) had negative NMB at the threshold, yet all documented recognized multi-criteria rationales. Among 47 rejections, 85.1% had modeled NMB under the non-adoption sign convention consistent with efficient non-adoption. Mean ordinal scores were 3.34 for policy use, 2.54 for health-sector benefit, 1.97 for capacity building and 1.87 for knowledge production.
Why this matters globally
As LMICs institutionalize HTA, Thailand demonstrates why transparency must cover both cost-effectiveness models and the social-value reasons used in deliberation. The study offers institutional evidence for designing HTA-to-reimbursement pathways.
Thai researcher contribution
Researchers across Thai universities, Siriraj and the Food and Drug Administration analyzed real National List of Essential Medicines decisions, turning Thailand’s experience into an international case on evidence-informed priority setting.
Limitations to consider
Retrospective scoring depends on available records and interpretation. NMB is sensitive to assumptions and sign conventions, while 14 lifetime-horizon studies generated 93.6% of that aggregate. There was no no-HTA comparator and no direct measurement of patient outcomes.