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Development of WHO guidelines on generalized cost‐effectiveness analysis


  • Christopher J.L. Murray
  • David B. Evans
  • Arnab Acharya
  • Rob M.P.M. Baltussen


The growing use of cost‐effectiveness analysis (CEA) to evaluate specific interventions is dominated by studies of prospective new interventions compared with current practice. This type of analysis does not explicitly take a sectoral perspective in which the costs and effectiveness of all possible interventions are compared, in order to select the mix that maximizes health for a given set of resource constraints. WHO guidelines on generalized CEA propose the application of CEA to a wide range of interventions to provide general information on the relative costs and health benefits of different interventions in the absence of various highly local decision constraints. This general approach will contribute to judgements on whether interventions are highly cost‐effective, highly cost‐ineffective, or something in between. Generalized CEAs require the evaluation of a set of interventions with respect to the counterfactual of the null set of the related interventions, i.e. the natural history of disease. Such general perceptions of relative cost‐effectiveness, which do not pertain to any specific decision‐maker, can be a useful reference point for evaluating the directions for enhancing allocative efficiency in a variety of settings. The proposed framework allows the identification of current allocative inefficiencies as well as opportunities presented by new interventions. Copyright © 1999 John Wiley & Sons, Ltd.

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  • Christopher J.L. Murray & David B. Evans & Arnab Acharya & Rob M.P.M. Baltussen, 2000. "Development of WHO guidelines on generalized cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 9(3), pages 235-251, April.
  • Handle: RePEc:wly:hlthec:v:9:y:2000:i:3:p:235-251
    DOI: 10.1002/(SICI)1099-1050(200004)9:3<235::AID-HEC502>3.0.CO;2-O

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    References listed on IDEAS

    1. Werner B. F. Brouwer & Marc A. Koopmanschap & Frans F. H. Rutten, 1997. "Productivity Costs Measurement Through Quality of Life? A Response to the Recommendation of the Washington Panel," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 253-259, May.
    2. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the 'Fair Innings' Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132.
    3. Birch, Stephen & Donaldson, Cam, 1987. "Cost-benefit analysis: Dealing with the problems of indivisible projects and fixed budgets," Health Policy, Elsevier, vol. 7(1), pages 61-72, February.
    4. Baltussen, Rob & Ament, Andre & Leidl, Reiner, 1996. "Making cost assessments based on RCTs more useful to decision-makers," Health Policy, Elsevier, vol. 37(3), pages 163-183, September.
    5. Blumstein, James F., 1997. "The Oregon experiment: The role of cost-benefit analysis in the allocation of Medicaid funds," Social Science & Medicine, Elsevier, vol. 45(4), pages 545-554, August.
    6. Birch, Stephen & Gafni, Amiram, 1994. "Cost-effectiveness ratios: in a league of their own," Health Policy, Elsevier, vol. 28(2), pages 133-141, May.
    7. Birch, Stephen & Gafni, Amiram, 1992. "Cost effectiveness/utility analyses : Do current decision rules lead us to where we want to be?," Journal of Health Economics, Elsevier, vol. 11(3), pages 279-296, October.
    8. Rovira, Joan, 1994. "Standardizing economic appraisal of health technology in the European community," Social Science & Medicine, Elsevier, vol. 38(12), pages 1675-1678, June.
    9. Kevin Schulman & Jennifer Burke & Michael Drummond & Linda Davies & Per Carlsson & Jans Gruger & Anthony Harris & Carlo Lucioni & Ramon Gisbert & Ted Llana & Eric Tom & Bernard Bloom & Richard Willke , 1998. "Resource costing for multinational neurologic clinical trials: methods and results," Health Economics, John Wiley & Sons, Ltd., vol. 7(7), pages 629-638, November.
    10. Nord, Erik & Richardson, Jeff & Street, Andrew & Kuhse, Helga & Singer, Peter, 1995. "Maximizing health benefits vs egalitarianism: An Australian survey of health issues," Social Science & Medicine, Elsevier, vol. 41(10), pages 1429-1437, November.
    11. Stinnett, Aaron A. & Paltiel, A. David, 1996. "Mathematical programming for the efficient allocation of health care resources," Journal of Health Economics, Elsevier, vol. 15(5), pages 641-653, October.
    12. Drummond, Michael & Mason, James & Torrance, George, 1995. "Cost-effectiveness league tables: think of the fans," Health Policy, Elsevier, vol. 31(3), pages 231-238, March.
    13. Eugene M. Laska & Morris Meisner & Carole Siegel, 1997. "The usefulness of average cost‐effectiveness ratios," Health Economics, John Wiley & Sons, Ltd., vol. 6(5), pages 497-504, September.
    14. Johannesson, Magnus & Weinstein, Milton C., 1993. "On the decision rules of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 12(4), pages 459-467, December.
    15. Andre Ament & Rob Baltussen, 1997. "The Interpretation of results of economic evaluation: explicating the value of health," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 625-635, November.
    16. Bossert, Walter, 1998. "Welfarism and rationalizability in allocation problems with indivisibilities1," Mathematical Social Sciences, Elsevier, vol. 35(2), pages 133-150, March.
    17. Alan M. Garber, 1999. "Advances in Cost-Effectiveness Analysis of Health Interventions," NBER Working Papers 7198, National Bureau of Economic Research, Inc.
    18. Karlsson, Göran & Johannesson, Magnus, 1998. "Cost-effectiveness analysis and capital costs," Social Science & Medicine, Elsevier, vol. 46(9), pages 1183-1191, May.
    19. Joanna Siegel & George Torrance & Louise Russell & Bryan Luce & Milton Weinstein & Marthe Gold, 1997. "Guidelines for Pharmacoeconomic Studies," PharmacoEconomics, Springer, vol. 11(2), pages 159-168, February.
    20. Jean‐François Baladi & Devidas Menon & Nicolaas Otten, 1998. "Use of economic evaluation guidelines: 2 years' experience in Canada," Health Economics, John Wiley & Sons, Ltd., vol. 7(3), pages 221-227, May.
    21. Drummond, Michael & Torrance, George & Mason, James, 1993. "Cost-effectiveness league tables: More harm than good?," Social Science & Medicine, Elsevier, vol. 37(1), pages 33-40, July.
    22. Richard J. Willke & Henry A. Glick & Daniel Polsky & Kevin Schulman, 1998. "Estimating country‐specific cost‐effectiveness from multinational clinical trials," Health Economics, John Wiley & Sons, Ltd., vol. 7(6), pages 481-493, September.
    23. Birch, Stephen & Gafni, Amiram, 1993. "Changing the problem to fit the solution: Johannesson and Weinstein's (mis) application of economics to real world problems," Journal of Health Economics, Elsevier, vol. 12(4), pages 469-476, December.
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    2. Rutten, Frans & Bleichrodt, Han & Brouwer, Werner & Koopmanschap, Marc & Schut, Erik, 2001. "Handbook of Health Economics," Journal of Health Economics, Elsevier, vol. 20(5), pages 855-879, September.
    3. Raymond C. W. Hutubessy & Louis W. Niessen & Rob F. Dijkstra & Ton F. Casparie & Frans F. Rutten, 2005. "Stochastic league tables: an application to diabetes interventions in the Netherlands," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 445-455, May.
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    5. Raymond C.W. Hutubessy & Rob M.P.M. Baltussen & David B. Evans & Jan J. Barendregt & Christopher J.L. Murray, 2001. "Stochastic league tables: communicating cost‐effectiveness results to decision‐makers," Health Economics, John Wiley & Sons, Ltd., vol. 10(5), pages 473-477, July.
    6. Milton C. Weinstein, 2012. "Decision Rules for Incremental Cost-effectiveness Analysis," Chapters, in: Andrew M. Jones (ed.),The Elgar Companion to Health Economics, Second Edition, chapter 47, Edward Elgar Publishing.
    7. Kapiriri, Lydia & Razavi, Donya, 2017. "How have systematic priority setting approaches influenced policy making? A synthesis of the current literature," Health Policy, Elsevier, vol. 121(9), pages 937-946.
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    11. Shepherd, Keith D. & Shepherd, Gemma & Walsh, Markus G., 2015. "Land health surveillance and response: A framework for evidence-informed land management," Agricultural Systems, Elsevier, vol. 132(C), pages 93-106.
    12. Bin Wu & Baijun Dong & Yuejuan Xu & Qiang Zhang & Jinfang Shen & Huafeng Chen & Wei Xue, 2012. "Economic Evaluation of First-Line Treatments for Metastatic Renal Cell Carcinoma: A Cost-Effectiveness Analysis in A Health Resource–Limited Setting," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-13, March.
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    16. Stephen Resch & Eline Korenromp & John Stover & Matthew Blakley & Carleigh Krubiner & Kira Thorien & Robert Hecht & Rifat Atun, 2011. "Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries," PLOS ONE, Public Library of Science, vol. 6(10), pages 1-9, October.
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    18. Ezzati, Majid & Kammen, Daniel M., 2002. "Evaluating the health benefits of transitions in household energy technologies in Kenya," Energy Policy, Elsevier, vol. 30(10), pages 815-826, August.
    19. Llanos, Adolfo & Hertrampf, Eva & Cortes, Fanny & Pardo, Andrea & Grosse, Scott D. & Uauy, Ricardo, 2007. "Cost-effectiveness of a folic acid fortification program in Chile," Health Policy, Elsevier, vol. 83(2-3), pages 295-303, October.
    20. David B. Evans & Dan Chisholm & Tessa Tan-Torres Edejer, 2012. "Generalized Cost-effectiveness Analysis: Principles and Practice," Chapters, in: Andrew M. Jones (ed.),The Elgar Companion to Health Economics, Second Edition, chapter 48, Edward Elgar Publishing.
    21. Baltussen, Rob & Youngkong, Sitapon & Paolucci, Francesco & Niessen, Louis, 2010. "Multi-criteria decision analysis to prioritize health interventions: Capitalizing on first experiences," Health Policy, Elsevier, vol. 96(3), pages 262-264, August.
    22. Gonzalo M Vazquez-Prokopec & Cynthia Spillmann & Mario Zaidenberg & Uriel Kitron & Ricardo E Gürtler, 2009. "Cost-Effectiveness of Chagas Disease Vector Control Strategies in Northwestern Argentina," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 3(1), pages 1-11, January.
    23. Robberstad, Bjarne & Norheim, Ole F., 2011. "Incorporating concerns for equal lifetime health in evaluations of public health programs," Social Science & Medicine, Elsevier, vol. 72(10), pages 1711-1716, May.
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    25. Hyder, Adnan A. & Aggarwal, Anju, 2009. "The increasing burden of injuries in Eastern Europe and Eurasia: Making the case for safety investments," Health Policy, Elsevier, vol. 89(1), pages 1-13, January.

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