Incremental cost-utility ratio

Signature

ICUR = Delta C / Delta QALY

Inputs
Inputs	Definition	Unit
`Delta`	Delta QALY — Difference in quality-adjusted life years between the intervention and comparator. Unit: QALYs per defined population or person	—
`Delta`	Delta QALY — Difference in quality-adjusted life years between the intervention and comparator. Unit: QALYs per defined population or person	—

Output
`ICUR`	Additional cost per additional quality-adjusted life year	currency per QALY gained

Maps incremental cost and incremental quality-adjusted life years to the additional cost per QALY gained.

DeltaDelta

Relevant comparator for cost-utility analysis
The comparator represents the healthcare choice actually available to the decision-maker.
Consistent analytical basis for cost-utility analysis
Costs and QALYs for both alternatives use the same population, perspective, time horizon and applicable discounting conventions.
Comparable QALY measurement
QALYs for both alternatives use compatible utility evidence and the same timing convention.
Non-zero incremental QALYs
Incremental QALYs are not zero because division by zero does not produce an interpretable ratio.
Dominance assessed
The signs of incremental cost and incremental QALYs are examined before the ratio is interpreted.

Cost per QALY gained
Current care costs £20,000 and produces 6.60 discounted QALYs. A new intervention costs £28,000 and produces 7.10 discounted QALYs. Incremental cost is £8,000 and incremental QALYs are 0.50.
```
ICUR = (28000-20000)/(7.10-6.60) = 16000 per QALY gained
```

Interpreting a negative ICUR mechanically
A negative ratio may indicate either dominance or being dominated and cannot be interpreted without examining incremental cost and incremental QALYs.

NICE manual for cost-utility analysis
NICE. Health technology evaluations: the manual. Section 4.6 Economic evaluation.
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