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Economic evaluation of communicable disease interventions in developing countries: a critical review of the published literature


  • Damian Walker

    (Health Economics and Financing Programme, Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK)

  • Julia A. Fox-Rushby

    (Health Economics and Financing Programme, Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK)


Limited health care budgets have emphasized the need for providers to use resources efficiently. Accordingly, there has been a rapid increase in the number of economic evaluations of communicable disease health programmes in developing countries, as there is a need to implement evidence-based policy decisions. However, given the prohibitive cost of many economic evaluations in low-income countries, interest has also been generated in pooling data and results of previously published studies. Yet, our review demonstrated that very few published economic evaluations have been performed during 1984-1997 (n=107). Certain diseases and geographical areas have also been neglected. Of those studies published, appropriate analytic techniques have been inconsistently applied. In particular, there are four immediate concerns: the narrow perspective taken-dominance of the health care provider viewpoint and reliance on intermediate outcomes measures; bias-some costs were excluded from estimates; the lack of transparency-sources of data not identified; and the absence of a critical examination of findings-many papers failed to perform a sensitivity analysis. The usefulness of previously published economic evaluations to help make resource allocation choices on an individual basis and, therefore, for the purpose of international comparisons, pooling or meta-analysis, has to be questioned in light of the results from this study. Copyright © 2000 John Wiley & Sons, Ltd.

Suggested Citation

  • Damian Walker & Julia A. Fox-Rushby, 2000. "Economic evaluation of communicable disease interventions in developing countries: a critical review of the published literature," Health Economics, John Wiley & Sons, Ltd., vol. 9(8), pages 681-698.
  • Handle: RePEc:wly:hlthec:v:9:y:2000:i:8:p:681-698
    DOI: 10.1002/1099-1050(200012)9:8<681::AID-HEC545>3.0.CO;2-X

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    References listed on IDEAS

    1. Jose‐Luis Bobadilla & Peter Cowley, 1995. "Designing and implementing packages of essential health services," Journal of International Development, John Wiley & Sons, Ltd., vol. 7(3), pages 543-554, May.
    2. Gerard, Karen, 1992. "Cost-utility in practice: A policy maker's guide to the state of the art," Health Policy, Elsevier, vol. 21(3), pages 249-279, July.
    3. Dinwiddy,Caroline L. & Teal,Francis J., 1996. "Principles of Cost-Benefit Analysis for Developing Countries," Cambridge Books, Cambridge University Press, number 9780521479165, March.
    4. Saunderson, Paul R., 1995. "An economic evaluation of alternative programme designs for tuberculosis control in rural Uganda," Social Science & Medicine, Elsevier, vol. 40(9), pages 1203-1212, May.
    5. Andrew Briggs & Mark Sculpher, 1995. "Sensitivity analysis in economic evaluation: A review of published studies," Health Economics, John Wiley & Sons, Ltd., vol. 4(5), pages 355-371, September.
    6. 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.
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    Cited by:

    1. Ngowu, Rufus & Larson, James S. & Kim, Min Su, 2008. "Reducing child mortality in Nigeria: A case study of immunization and systemic factors," Social Science & Medicine, Elsevier, vol. 67(1), pages 161-164, July.
    2. Ranson, Kent & Law, Tyler J. & Bennett, Sara, 2010. "Establishing health systems financing research priorities in developing countries using a participatory methodology," Social Science & Medicine, Elsevier, vol. 70(12), pages 1933-1942, June.
    3. Grupo de Economía de la Salud & Jairo Humberto Restrepo, 2006. "Evaluación económica en salud: tópicos teóricos y aplicaciones en ColombiaEsta Observación pretende motivar el estudio y aplicación de esta área de trabajo de la Economía de la Salud en Colombia, adem," OBSERVATORIO SEGURIDAD SOCIAL 015588, GRUPO DE ECONOMÍA DE LA SALUD.
    4. Sun-Young Kim & Sue Goldie, 2008. "Cost-Effectiveness Analyses of Vaccination Programmes," PharmacoEconomics, Springer, vol. 26(3), pages 191-215, March.
    5. Maria-Florencia Hutter & Roberto Rodríguez-Ibeas & Fernando Antonanzas, 2014. "Methodological reviews of economic evaluations in health care: what do they target?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 829-840, November.
    6. Samuel Shillcutt & Damian Walker & Catherine Goodman & Anne Mills, 2009. "Cost Effectiveness in Low- and Middle-Income Countries," PharmacoEconomics, Springer, vol. 27(11), pages 903-917, November.
    7. Kittiphong Thiboonboon & Benjarin Santatiwongchai & Varit Chantarastapornchit & Waranya Rattanavipapong & Yot Teerawattananon, 2016. "A Systematic Review of Economic Evaluation Methodologies Between Resource-Limited and Resource-Rich Countries: A Case of Rotavirus Vaccines," Applied Health Economics and Health Policy, Springer, vol. 14(6), pages 659-672, December.
    8. Amanda Glassman & Kalipso Chalkidou, 2012. "Priority-Setting in Health: Building Institutions for Smarter Public Spending," Working Papers id:5043, eSocialSciences.

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