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  • 1 Corvinus University of Budapest Department of Public Management, Health-economics and Health Technology Assessment Research Centre Budapest Hungary
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Health technology assessment (HTA) is a dynamic, rapidly evolving process embracing different types of assessment that inform decisions about the value (i.e., benefits, risks and costs) of new and existing technologies. The role of HTA is to support health policy decision-making and financing in health care. In this paper we describe and analyse the German approach to cost-effectiveness analysis in health care and HTA. Two institutes operate as HTA agencies, namely the German Agency of Health Technology Assessment (DAHTA) and the Institute for Quality and Efficiency in Health Care (IQWiG). The operational principles of IQWiG are somewhat different from the rules governing HTA organizations in other countries. The efficiency frontier approach, applying an indication-specific threshold and neglecting the concept of quality-adjusted life year (QALY) are the most important differences. Previously, health gains were in focus and assessment was based exclusively on such benefits, but in 2010, cost-effectiveness analysis was introduced as an integral part of the HTA process at IQWiG. A brief comparison is also made with the HTA systems in Central-Eastern-European countries, among them concentrating mainly on Hungary.

  • Baji, P. - Pavlova, M. - Gulácsi, L. - Groot, W. (2012a): Changes in Equity in Out-of-pocket Payments during the Period of Health Care Reforms: Evidence from Hungary. International Journal for Equity in Health 11: 36.

    Groot W , 'Changes in Equity in Out-of-pocket Payments during the Period of Health Care Reforms: Evidence from Hungary ' (2012 ) 11 International Journal for Equity in Health : 36 -.

    • Search Google Scholar
  • Baji, P. - Boncz, I. - Jenei, G. - Gulácsi, L. (2012b): Comparing Cost-sharing Practices for Pharmaceuticals and Health Care Services among four Central-European Countries. Society and Economy 34(2): 221–240.

    Gulácsi L , 'Comparing Cost-sharing Practices for Pharmaceuticals and Health Care Services among four Central-European Countries ' (2012 ) 34 Society and Economy : 221 -240.

    • Search Google Scholar
  • Bekkering, G. E. - Kleijnen, J. (2008): Procedures and Methods of Benefit Assessments for Medicines in Germany. European Journal of Health Economics 9(Suppl 1): S5–29.

    Kleijnen J , 'Procedures and Methods of Benefit Assessments for Medicines in Germany ' (2008 ) 9 European Journal of Health Economics : S5 -29.

    • Search Google Scholar
  • Betlehem, J. - Kriszbacher, I. - Oláh, A. - Boncz, I. - Sebestyén, A. - Marton, J. - Nagy, G. - Gulácsi, L. - Bódis, J. - Veres, R. (2008): The patients safety standards of acute stroke management in Hungary. Value in Health 11(3): A/217.

    Veres R , 'The patients safety standards of acute stroke management in Hungary ' (2008 ) 11 Value in Health : A/217 -.

    • Search Google Scholar
  • Boncz, I. - Brodszky, V. - Péntek, M. - Ágoston, I. - Nagy, Z. - Kárpáti, K. - Kriszbacher, I. - Fuszek, P. - Gulácsi, L. (2010): The Disease Burden of Colorectal Cancer in Hungary. European Journal of Health Economics 10(1): S35–40.

    Gulácsi L , 'The Disease Burden of Colorectal Cancer in Hungary ' (2010 ) 10 European Journal of Health Economics : S35 -40.

    • Search Google Scholar
  • Boncz, I. - Dózsa, C. - Kaló, Z. - Nagy, L. - Borcsek, B. - Brandtmüller, Á. - Betlehem, J. - Sebestyén, A. - Gulácsi, L. (2006): Development of Health Economics in Hungary between 1990–2006. European Journal of Health Economics 7(Suppl 1): 4–6.

    Gulácsi L , 'Development of Health Economics in Hungary between 1990–2006 ' (2006 ) 7 European Journal of Health Economics : 4 -6.

    • Search Google Scholar
  • Drummond, M (2007): Technology Assessment in the German Context. European Journal of Health Economics 8(Suppl 1): S3.

    Drummond M , 'Technology Assessment in the German Context ' (2007 ) 8 European Journal of Health Economics : S3 -.

    • Search Google Scholar
  • Fricke, F. U. - Dauben, H. P. (2009): Health Technology Assessment: A Perspective from Germany. Value in Health 12(Suppl 2): S20–27.

    Dauben H P , 'Health Technology Assessment: A Perspective from Germany ' (2009 ) 12 Value in Health : S20 -27.

    • Search Google Scholar
  • Greiner, W. - Schulenburg, J-M. (2010): HTA in Germany: Very Special and Specific. European Journal of Health Economics 11: 1–3.

    Schulenburg J-M , 'HTA in Germany: Very Special and Specific ' (2010 ) 11 European Journal of Health Economics : 1 -3.

    • Search Google Scholar
  • Gulácsi, L. (2007): The Time for Cost-effectiveness in the New European Union Member States. The Development and Role of Health Economics and Technology Assessment in the Mirror of the Hungarian Experience. European Journal of Health Economics 8(2): 83–88.

    Gulácsi L , 'The Time for Cost-effectiveness in the New European Union Member States. The Development and Role of Health Economics and Technology Assessment in the Mirror of the Hungarian Experience ' (2007 ) 8 European Journal of Health Economics : 83 -88.

    • Search Google Scholar
  • Gulácsi, L. - Orlewska, E. - Péntek, M. (2012): Health Economics and Health Technology Assessment in Central and Eastern Europe: A Dose of Reality. European Journal of Health Economics 13: 525–531.

    Péntek M , 'Health Economics and Health Technology Assessment in Central and Eastern Europe: A Dose of Reality ' (2012 ) 13 European Journal of Health Economics : 525 -531.

    • Search Google Scholar
  • Gulácsi, L. - Brodszky, V. - Péntek, M. - Varga, S. - Vas, G. - Boncz, I. (2009): History of Health Technology Assessment in Hungary. International Journal of Technology Assessment in Health Care 1: 120–126.

    Boncz I , 'History of Health Technology Assessment in Hungary ' (2009 ) 1 International Journal of Technology Assessment in Health Care : 120 -126.

    • Search Google Scholar
  • Inotai, A. - Pékli, M. - Jóna, G. - Nagy, O. - Remák, E. - Kaló, Z. (2012): Attempt to Increase the Transparency of Fourth Hurdle Implementation in Central-Eastern European Middle Income Countries: Publication of the Critical Appraisal Methodology. BMC Health Services Research 12: 332.

    Kaló Z , 'Attempt to Increase the Transparency of Fourth Hurdle Implementation in Central-Eastern European Middle Income Countries: Publication of the Critical Appraisal Methodology ' (2012 ) 12 BMC Health Services Research : 332 -.

    • Search Google Scholar
  • IQWiG (2006): General Methods 2.0. https://www.iqwig.de/index.925.en.html , accessed on 01.08.2012

    '', in General Methods 2.0 , (2006 ) -.

  • IQWiG (2011): General Methods 4.0. https://www.iqwig.de/index.428.en.html , accessed on 02.08.2012

    '', in General Methods 4.0 , (2011 ) -.

  • Jönsson, B. (2007): Economic Evaluation for Pharmaceuticals in Germany. European Journal of Health Economics 8(Suppl 1): S1–2.

    Jönsson B , 'Economic Evaluation for Pharmaceuticals in Germany ' (2007 ) 8 European Journal of Health Economics : S1 -2.

    • Search Google Scholar
  • Jönsson, B. (2008): IQWiG: An Opportunity Lost? European Journal of Health Economics 9(3): 205–207.

    Jönsson B , 'IQWiG: An Opportunity Lost? ' (2008 ) 9 European Journal of Health Economics : 205 -207.

    • Search Google Scholar
  • Markowitz, H. (1952): Portfolio Selection. The Journal of Finance 7(1): 77–91.

    Markowitz H , 'Portfolio Selection ' (1952 ) 7 The Journal of Finance : 77 -91.

  • Minier, T. - Péntek, M. - Brodszky, V. - Ecseki, A. - Kárpáti,.K. - Polgár, A. - Czirják, L. - Gulácsi, L. (2010): Cost-of-illness of Patients with Systemic Sclerosis. Rheumatology 49(10): 1920–1928.

    Gulácsi L , 'Cost-of-illness of Patients with Systemic Sclerosis ' (2010 ) 49 Rheumatology : 1920 -1928.

    • Search Google Scholar
  • Pauly, M. V. - McGuire, T. G. - Barros, P. P. (2012): Handbook of Health Economics. Oxford: North Holland.

    Barros P P , '', in Handbook of Health Economics , (2012 ) -.

  • Péntek, M. - Kobelt, M. - Czirják, L. - Szekanecz, Z. - Poór, G. - Rojkovich, B. - Polgár, A. - Genti, G. - György Kiss, C. - Brodszky, V. - Májer, I. - Gulácsi, L. (2007): Costs of Rheumatoid Arthritis in Hungary. Journal of Rheumatology 34: 1437–1439.

    Gulácsi L , 'Costs of Rheumatoid Arthritis in Hungary ' (2007 ) 34 Journal of Rheumatology : 1437 -1439.

    • Search Google Scholar
  • Péntek, M. - Horváth, C. - Boncz, I. - Falusi, Z. - Tóth, E. - Sebestyén, A. - Majer, I. - Brodszky, V. - Gulácsi, L. (2008): Epidemiology of Osteoporosis Related Fractures in Hungary from the Nationwide Health Insurance Database, 1999–2003. Osteoporosis International 19: 243–249.

    Gulácsi L , 'Epidemiology of Osteoporosis Related Fractures in Hungary from the Nationwide Health Insurance Database, 1999–2003 ' (2008 ) 19 Osteoporosis International : 243 -249.

    • Search Google Scholar
  • Schulenburg, J-M. - Vauth, C. - Mittendorf, T. - Greiner, W. (2007): Methods for Determining Cost-benefit Ratios for Pharmaceuticals in Germany. The European Journal of Health Economics 8(S1): S5–31.

    Greiner W , 'Methods for Determining Cost-benefit Ratios for Pharmaceuticals in Germany ' (2007 ) 8 The European Journal of Health Economics : S5 -31.

    • Search Google Scholar
  • Sebestyén, A. - Boncz, I. - Molnár, A. - Kőrösi, L. - Kriszbacher, I. - Brodszky, V. - Gulácsi, L. (2009): The Relationship between Surgical Delay over 24 hours and 30 Days Mortality Following Femoral Neck Fracture in the Presence of Different Co-morbidities. ISPOR Fourteenth Annual International Meeting Research Abstracts, Value in Health 12(3), PMS14, A66.

    Gulácsi L , 'The Relationship between Surgical Delay over 24 hours and 30 Days Mortality Following Femoral Neck Fracture in the Presence of Different Co-morbidities ' (2009 ) 12 Value in Health : A66 -.

    • Search Google Scholar
  • Siebert, U (2010): Approaches to Economic Evaluation at German Agencies for HTA [oral presentation]. Workshop on Economic Analysis of Nutrition Interventions, February 23–24. Bethesda, ML, USA.

    Siebert U , '', in Approaches to Economic Evaluation at German Agencies for HTA , (2010 ) -.

  • Torpy, J. M. - Lynm, C. - Glass, R. M. (2006): JAMA Patient Page. Evidence-based Medicine. JAMA 296(9): 1192.

    Glass R M , 'JAMA Patient Page. Evidence-based Medicine ' (2006 ) 296 JAMA : 1192 -.

  • Vártokné Hevér, N. (2012): Egészségügyi reform Horvátországban [Healthcare reform in Croatia]. Köz-Gazdaság 7(3): 177–190.

    Vártokné Hevér N , 'Egészségügyi reform Horvátországban ' (2012 ) 7 Köz-Gazdaság : 177 -190.

    • Search Google Scholar
  • Weinstein, M. C. - Torrance, G. - McGuire, A. (2009): QALYs: The Basics. Value in Health 12(Suppl 1): S5–9.

    McGuire A , 'QALYs: The Basics ' (2009 ) 12 Value in Health : S5 -9.