Value of a QALY for France: A New Approach to Propose Acceptable Reference Values

France has included health economic assessment (HEA) as an official criterion for innovative drug pricing since 2013. Until now, no cost-effectiveness threshold (CET) has been officially proposed to qualify incremental cost-effectiveness ratios (ICERs). Although the French health authorities have publicly expressed the need for such reference values, previous initiatives to determine these have failed. The study aims to propose a locally adapted method for estimating a preference-based value for a quality-adjusted life-year (QALY) based on a rational approach to public policy choices in France. We used the official French value of statistical life (VSL) of €3 million (USD 3.25 million), proposed in 2013 by the French General Commission on Strategy and Prediction. We first estimated the value of life-year (VoLY) by age category according to life expectancy and official discounts recommended for HEA in France. We then estimated a value of statistical QALY (VSQ) by weighting VoLYs with demographic data and French EQ-5D-3L tariffs. The estimated average VoLYs and VSQs were €120 185 (USD 130 000) and €147 093 (USD 159 022), respectively, assuming a discount rate of 2.5% and €166 205 (USD 179 681) and €201 398 (USD 217 728), respectively, assuming a discount rate of 4.5%. Assuming that, as in other public domains, equity in access to healthcare across all disease areas and between all users is desirable, we propose an estimate of VSQ that is consistent with this goal. Our estimates of €147 093 (USD 179,681) to €201 398 (USD 217 728) should be perceived as breakeven costs for a QALY rather than a market access threshold. Such VSQs could be used as reference values for ICERs in HEA in France. •Cost-effectiveness thresholds are used in many countries to inform reimbursement and pricing decisions, although no such reference threshold has yet been proposed in France.•The value of statistical life (VSL) is an interesting metric for evaluating cost-effectiveness thresholds in healthcare because (1) it can be tailored for individual countries using local utility data, (2) it provides a unique measure to avoid inequity in access to healthcare between different therapeutic domains, and (3) it can be benchmarked against other social domains, where it is used to assess public policies and investments that affect mortality risk.•We propose VSL-based breakeven values for a QALY of €147 093 to €201 398, which could be used to qualify incremental cost-effectiveness ratios in he