Affordability Decision Rules Framework (budget-impact threshold categorisation)
This method helps health systems decide how expensive a new health intervention is by comparing its cost to the total health budget. It groups costs into four levels—low, moderate, high, and very high—based on how much of the country's health spending they would use. This helps policymakers understand the financial impact and make better decisions about funding new treatments.
At a glance
Use when
Deciding on the affordability of new health technologies; supporting HTA deliberations; benchmarking budget impact across countries; developing or refining national threshold policies
Avoid when
Used as a rigid cutoff for funding decisions; applied without considering local health system priorities, capacity, or equity concerns
Inputs
Budget impact of a health intervention, total health expenditure of a country
Outputs
Categorisation of budget impact into low, moderate, high, or very high levels
How it works
The Affordability Decision Rules Framework identifies and standardises budget impact thresholds (BITs) used across health systems by expressing them as a proportion of a country's total health expenditure. Based on a systematic review and consultation with HTA agencies, it proposes four empirically derived categories: low (<0.005%), moderate (0.005% to <0.01%), high (0.01% to <0.02%), and very high (≥0.02%). These categories are designed to support cross-country comparisons and inform deliberative processes in health technology assessment and coverage decision-making.
- HTA domains
- Costs & Economic Evaluation, Organisational aspects
- Assumptions
- Budget impact thresholds reflect policy relevance; higher thresholds correspond to more stringent policy actions; health expenditure data are reliable and comparable across countries
- Strengths
- Provides a standardised, data-driven framework for cross-country comparison; based on real-world thresholds and systematic review; applicable to 182 countries using publicly available data
- Limitations
- Not a standalone decision tool; requires contextual adaptation; does not replace local HTA or cost-effectiveness analysis; limited by variability in how countries define and apply thresholds
- Also known as
- Affordability Decision Rules Framework, Budget Impact Threshold Categorisation Framework
Questions this answers
- › How can budget impact of a new health intervention be categorised in relation to a country's health expenditure?
- › What level of budget impact should trigger different policy responses?
- › How do current budget impact thresholds vary across countries?
- › How can budget impact be standardised for international comparison?
- › What proportion of health expenditure constitutes a low, moderate, high, or very high budget impact?
- › How can countries without formal thresholds benchmark affordability?
References & sources
Similar by meaning
- Budget Impact Analysis—Principles of Good Practice
- Cost-Effective but Unaffordable Paradox / Nonmarginal Health Opportunity Cost Method
- ISPOR Budget Impact Analysis Principles (2007)
- National Guidelines for the Budget Impact Analysis of Health Technologies in Ireland (HIQA)
- HTA306 Local Budget Impact Analysis Tool
Beta record. Generated from the primary source via AI extraction and independent audit, pending final human review.