IDEAS home Printed from https://ideas.repec.org/p/chy/respap/98cherp.html
   My bibliography  Save this paper

Using cost-effectiveness thresholds to determine value for money in low- and middle-income country healthcare systems: Are current international norms fit for purpose?

Author

Listed:
  • Paul Revill

    (Centre for Health Economics, University of York, UK)

  • Simon Walker

    (Centre for Health Economics, University of York, UK)

  • Jason Madan

    (Warwick Medical School, University of Warwick, UK)

  • Andrea Ciaranello

    (Massachusetts General Hospital, Massachusetts, USA)

  • Takondwa Mwase

    (Abt Associates, Lilongwe, Malawi)

  • Diana M Gibb

    (5Medical Research Council Clinical Trials Unit (MRC CTU), at University College London, UK)

  • Karl Claxton

    (Centre for Health Economics, University of York, UK)

  • Mark J Sculpher

    (Centre for Health Economics, University of York, UK)

Abstract

Healthcare systems in low- and middle-income countries face considerable population healthcare needs with markedly fewer resources than those in higher income countries. The way in which available resources are allocated across competing priorities has a profound effect on how much health is generated overall, who receives healthcare interventions and who goes without. Judgements about whether interventions and programmes should be regarded as cost-effective and prioritised over others should be based on an assessment of the health benefits that will be lost because the resources required will not be available to implement other effective interventions and programmes that would benefit other patients in the same or different disease areas. Unfortunately, frequently adopted international norms, in particular the cost-effectiveness thresholds recommended by the World Health Organization (WHO), are not founded on this type of assessment. Consequently current judgements about which interventions and programmes are cost-effective are often aspirational and do not reflect the reality of resource constraints. As a consequence their use is likely to reduce overall population health and exacerbate healthcare inequalities. They also fail to identify the real (and greater) value of devoting more resources to these efforts. By obscuring the true implications of current arrangements they do not contribute to greater understanding of and accountability for global and local decisions made on behalf of populations in low and middle as well as in high income countries. We illustrate these points using examples from HIV/AIDS.

Suggested Citation

  • Paul Revill & Simon Walker & Jason Madan & Andrea Ciaranello & Takondwa Mwase & Diana M Gibb & Karl Claxton & Mark J Sculpher, 2014. "Using cost-effectiveness thresholds to determine value for money in low- and middle-income country healthcare systems: Are current international norms fit for purpose?," Working Papers 098cherp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:98cherp
    as

    Download full text from publisher

    File URL: http://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP98_costeffectiveness_thresholds_value_low_middle_income_countries.pdf
    File Function: First version, 2014
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Rodrigo Moreno-Serra & Peter C. Smith, 2015. "Broader health coverage is good for the nation's health: evidence from country level panel data," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 178(1), pages 101-124, January.
    2. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Opportunity costs, marginal productivity, and cost-effectiveness thresholds: what are they and how are they related?
      by Rita Faria, Jessica Ochalek, jameslomas88 in The Academic Health Economists' Blog on 2020-09-23 06:00:00

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Ryota Nakamura & James Lomas & Karl Claxton & Farasat Bokhari & Rodrigo Moreno-Serra & Marc Suhrcke & Peter Berman, 2020. "Assessing the Impact of Health Care Expenditures on Mortality Using Cross-Country Data," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 1, pages 3-49, World Scientific Publishing Co. Pte. Ltd..
    2. Tom L. Drake & Angela Devine & Shunmay Yeung & Nicholas P. J. Day & Lisa J. White & Yoel Lubell, 2016. "Dynamic Transmission Economic Evaluation of Infectious Disease Interventions in Low‐ and Middle‐Income Countries: A Systematic Literature Review," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 124-139, February.
    3. Culyer, Anthony J., 2016. "Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use," Health Economics, Policy and Law, Cambridge University Press, vol. 11(4), pages 415-432, October.
    4. Anthony J Culyer, 2015. "Efficiency, equity and equality in health and health care," Working Papers 120cherp, Centre for Health Economics, University of York.
    5. 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.
    6. 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.
    7. Mujaheed Shaikh & Afschin Gandjour, 2019. "Pharmaceutical expenditure and gross domestic product: Evidence of simultaneous effects using a two‐step instrumental variables strategy," Health Economics, John Wiley & Sons, Ltd., vol. 28(1), pages 101-122, January.
    8. Jessica Ochalek & Miqdad Asaria & Pei Fen Chuar & James Lomas & Sumit Mazumdar & Karl Claxton, 2019. "Assessing health opportunity costs for the Indian health care systems," Working Papers 161cherp, Centre for Health Economics, University of York.
    9. Beth Woods & Paul Revill & Mark Sculpher & Karl Claxton, 2015. "Country-level cost-effectiveness thresholds: initial estimates and the need for further research," Working Papers 109cherp, Centre for Health Economics, University of York.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Beth Woods & Paul Revill & Mark Sculpher & Karl Claxton, 2015. "Country-level cost-effectiveness thresholds: initial estimates and the need for further research," Working Papers 109cherp, Centre for Health Economics, University of York.
    2. Peter J. Neumann & David D. Kim & Thomas A. Trikalinos & Mark J. Sculpher & Joshua A. Salomon & Lisa A. Prosser & Douglas K. Owens & David O. Meltzer & Karen M. Kuntz & Murray Krahn & David Feeny & An, 2018. "Future Directions for Cost-effectiveness Analyses in Health and Medicine," Medical Decision Making, , vol. 38(7), pages 767-777, October.
    3. Andrew J. Mirelman & Miqdad Asaria & Bryony Dawkins & Susan Griffin & Richard Cookson & Peter Berman, 2020. "Fairer Decisions, Better Health for All: Health Equity and Cost-Effectiveness Analysis," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 4, pages 99-132, World Scientific Publishing Co. Pte. Ltd..
    4. Eldon Spackman & Stewart Richmond & Mark Sculpher & Martin Bland & Stephen Brealey & Rhian Gabe & Ann Hopton & Ada Keding & Harriet Lansdown & Sara Perren & David Torgerson & Ian Watt & Hugh MacPherso, 2014. "Cost-Effectiveness Analysis of Acupuncture, Counselling and Usual Care in Treating Patients with Depression: The Results of the ACUDep Trial," PLOS ONE, Public Library of Science, vol. 9(11), pages 1-12, November.
    5. Paul Revill & Simon Walker & Valentina Cambiano & Andrew Phillips & Mark J Sculpher, 2018. "Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-13, January.
    6. Hareth Al-Janabi & Job van Exel & Werner Brouwer & Joanna Coast, 2016. "A Framework for Including Family Health Spillovers in Economic Evaluation," Medical Decision Making, , vol. 36(2), pages 176-186, February.
    7. Ken Willis & Bob Crabtree & Liesl M. Osman & Kirsty Cathrine, 2016. "Green space and health benefits: a QALY and CEA of a mental health programme," Journal of Environmental Economics and Policy, Taylor & Francis Journals, vol. 5(2), pages 163-180, July.
    8. Ryen, Linda & Svensson, Mikael, 2014. "The Willingness to Pay for a QALY: a Review of the Empirical Literature," Karlstad University Working Papers in Economics 12, Karlstad University, Department of Economics.
    9. Rieger, M. & Wagner, N. & Bedi, A.S., 2015. "Macroeconomic impacts of Universal Health Coverage : Synthetic control evidence from Thailand," ISS Working Papers - General Series 609, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    10. Ryota Nakamura & James Lomas & Karl Claxton & Farasat Bokhari & Rodrigo Moreno-Serra & Marc Suhrcke & Peter Berman, 2020. "Assessing the Impact of Health Care Expenditures on Mortality Using Cross-Country Data," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 1, pages 3-49, World Scientific Publishing Co. Pte. Ltd..
    11. Mujaheed Shaikh & Afschin Gandjour, 2019. "Pharmaceutical expenditure and gross domestic product: Evidence of simultaneous effects using a two‐step instrumental variables strategy," Health Economics, John Wiley & Sons, Ltd., vol. 28(1), pages 101-122, January.
    12. Miqdad Asaria & Susan Griffin & Richard Cookson, 2016. "Distributional Cost-Effectiveness Analysis," Medical Decision Making, , vol. 36(1), pages 8-19, January.
    13. Donna Rowen & John Brazier & Clara Mukuria & Anju Keetharuth & Arne Risa Hole & Aki Tsuchiya & Sophie Whyte & Phil Shackley, 2016. "Eliciting Societal Preferences for Weighting QALYs for Burden of Illness and End of Life," Medical Decision Making, , vol. 36(2), pages 210-222, February.
    14. B. Rodríguez-Sánchez & L. M. Peña-Longobardo & A. J. Sinclair, 2020. "Cost-effectiveness analysis of the Neuropad device as a screening tool for early diabetic peripheral neuropathy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 335-349, April.
    15. Wa Ntita Serge Kabongo & Josue Mbonigaba, 2017. "Demand-side Determinants of Access to Healthcare Services: Empirical Evidence from Africa," SPOUDAI Journal of Economics and Business, SPOUDAI Journal of Economics and Business, University of Piraeus, vol. 67(4), pages 3-22, October-D.
    16. Rieger, Matthias & Wagner, Natascha & Bedi, Arjun S., 2017. "Universal health coverage at the macro level: Synthetic control evidence from Thailand," Social Science & Medicine, Elsevier, vol. 172(C), pages 46-55.
    17. Alec Morton & Amanda I. Adler & David Bell & Andrew Briggs & Werner Brouwer & Karl Claxton & Neil Craig & Alastair Fischer & Peter McGregor & Pieter van Baal, 2016. "Unrelated Future Costs and Unrelated Future Benefits: Reflections on NICE Guide to the Methods of Technology Appraisal," Health Economics, John Wiley & Sons, Ltd., vol. 25(8), pages 933-938, August.
    18. Miqdad Asaria & Susan Griffin & Richard Cookson, 2013. "Distributional cost-effectiveness analysis: a tutorial," Working Papers 092cherp, Centre for Health Economics, University of York.
    19. 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.
    20. Mike Paulden & Tania Stafinski & Devidas Menon & Christopher McCabe, 2015. "Value-Based Reimbursement Decisions for Orphan Drugs: A Scoping Review and Decision Framework," PharmacoEconomics, Springer, vol. 33(3), pages 255-269, March.

    More about this item

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:chy:respap:98cherp. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: https://edirc.repec.org/data/chyoruk.html .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Gill Forder (email available below). General contact details of provider: https://edirc.repec.org/data/chyoruk.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.