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Are Current Cost-Effectiveness Thresholds for Low- and Middle-Income Countries Useful? Examples from the World of Vaccines

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  • A. Newall
  • M. Jit
  • R. Hutubessy

Abstract

The World Health Organization’s CHOosing Interventions that are Cost Effective (WHO-CHOICE) thresholds for averting a disability-adjusted life-year of one to three times per capita income have been widely cited and used as a measure of cost effectiveness in evaluations of vaccination for low- and middle-income countries (LMICs). These thresholds were based upon criteria set out by the WHO Commission on Macroeconomics and Health, which reflected the potential economic returns of interventions. The CHOICE project sought to evaluate a variety of health interventions at a subregional level and classify them into broad categories to help assist decision makers, but the utility of the thresholds for within-country decision making for individual interventions (given budgetary constraints) has not been adequately explored. To examine whether the ‘WHO-CHOICE thresholds’ reflect funding decisions, we examined the results of two recent reviews of cost-effectiveness analyses of human papillomavirus and rotavirus vaccination in LMICs, and we assessed whether the results of these studies were reflected in funding decisions for these vaccination programmes. We found that in many cases, programmes that were deemed cost effective were not subsequently implemented in the country. We consider the implications of this finding, the advantages and disadvantages of alternative methods to estimate thresholds, and how cost perspectives and the funders of healthcare may impact on these choices. Copyright Springer International Publishing Switzerland 2014

Suggested Citation

  • A. Newall & M. Jit & R. Hutubessy, 2014. "Are Current Cost-Effectiveness Thresholds for Low- and Middle-Income Countries Useful? Examples from the World of Vaccines," PharmacoEconomics, Springer, vol. 32(6), pages 525-531, June.
    • Handle: RePEc:spr:pharme:v:32:y:2014:i:6:p:525-531
    DOI: 10.1007/s40273-014-0162-x
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    2. McCabe, C & Claxton, K & Culyer, AJ, 2008. "The NICE Cost-Effectiveness Threshold: What it is and What that Means," MPRA Paper 26466, University Library of Munich, Germany.
    3. Alan Williams, 2004. "What Could be Nicer than NICE?," Monograph 000489, Office of Health Economics.
    4. Karl Claxton & Steve Martin & Marta Soares & Nigel Rice & Eldon Spackman & Sebastian Hinde & Nancy Devlin & Peter C Smith & Mark Sculpher, 2013. "Methods for the estimation of the NICE cost effectiveness threshold," Working Papers 081cherp, Centre for Health Economics, University of York.
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    1. Javad Moradpour & Aidan Hollis, 2021. "The economic theory of cost‐effectiveness thresholds in health: Domestic and international implications," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 1139-1151, May.
    2. Gerhart Knerer & Christine S M Currie & Sally C Brailsford, 2020. "The economic impact and cost-effectiveness of combined vector-control and dengue vaccination strategies in Thailand: results from a dynamic transmission model," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 14(10), pages 1-32, October.
    3. Thomas M Harmon & Kevin A Fisher & Margaret G McGlynn & John Stover & Mitchell J Warren & Yu Teng & Arne Näveke, 2016. "Exploring the Potential Health Impact and Cost-Effectiveness of AIDS Vaccine within a Comprehensive HIV/AIDS Response in Low- and Middle-Income Countries," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-18, January.
    4. Jessica Ochalek & James Lomas & Karl Claxton, 2015. "Cost per DALY averted thresholds for low- and middle-income countries: evidence from cross country data," Working Papers 122cherp, Centre for Health Economics, University of York.
    5. Jessica Ochalek & Karl Claxton & Paul Revill & Mark Sculpher & Alexandra Rollinger, 2016. "Supporting the development of an essential health package: principles and initial assessment for Malawi," Working Papers 136cherp, Centre for Health Economics, University of York.
    6. Bernard O. Okeah & Colin H. Ridyard, 2020. "Factors Influencing the Cost-Effectiveness Outcomes of HPV Vaccination and Screening Interventions in Low-to-Middle-Income Countries (LMICs): A Systematic Review," Applied Health Economics and Health Policy, Springer, vol. 18(5), pages 641-654, October.
    7. Guido España & Yutong Yao & Kathryn B Anderson & Meagan C Fitzpatrick & David L Smith & Amy C Morrison & Annelies Wilder-Smith & Thomas W Scott & T Alex Perkins, 2019. "Model-based assessment of public health impact and cost-effectiveness of dengue vaccination following screening for prior exposure," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 13(7), pages 1-21, July.

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