Cost–effectiveness thresholds: pros and cons

Bertram, Melanie; Lauer, Jeremy A.; Joncheere, Kees de; Edejer, Tessa Tan-Torres; Hutubessy, Raymond; Kiény, Marie Paule; Hill, Suzanne

doi:10.2471/blt.15.164418

Cited by 560 publications

(497 citation statements)

References 31 publications

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“…The WHO initially recommended that the WTP threshold per DALY averted be set at one to three times the gross domestic product (GDP) per capita [64], but recently re-emphasised that decisions need to be context-specific and that other factors, such as feasibility and budget impact, should also be considered [65]. This guidance is in line with recent studies that have suggested that the WTP threshold should be much lower [66,67].…”

Section: Chapter 1 Introductionsupporting

confidence: 62%

The Economics of Vivax Malaria Treatment

Devine¹

2018

Preprint

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The control and eventual elimination of malaria will require widescale adoption of strategies to ensure early diagnosis and highly effective treatment of infected individuals. In Plasmodium vivax, multiple relapse episodes can only be averted by treating the dormant liver stage of the parasite life cycle -a strategy known as radical cure. This thesis aims to investigate key factors determining treatment-seeking behaviour and costs associated with vivax malaria, how these influence healthcare decisions, the cost-effectiveness of screening tests and treatments for radical cure, and the cost-benefit implications of their global implementation.Treatment-seeking behaviour, assessed in Papua, Indonesia, demonstrated that household costs per person seeking treatment for vivax malaria were similar to those for falciparum malaria. Switching from ineffective to effective malaria treatment in the public sector improved the behaviour of patients and both public and private healthcare providers. Diagnostic strategies were investigated on the Thai-Myanmar border, where screening for glucose-6-phosphate-dehydrogenase (G6PD) deficiency prior to radical cure reduced the disease burden while being a cost-effective option for healthcare providers that do not use radical cure and a potentially cost-saving alternative where primaquine is prescribed without screening. The costs of implementing G6PD screening were collected in three countries, and highlighted that RDTs consistently reduced costs as compared to the widely-used fluorescent spot test. Across four countries, the indirect cost due to lost productivity was the largest cost component for households of patients with vivax malaria. After combining provider and patient costs with case estimates, the global economic burden of vivax malaria was estimated to be US$330 million per year. Adopting a policy of screening for G6PD deficiency with delivery of highly effective radical cure was projected to save US$45 million.P. vivax malaria causes a large economic burden that can be reduced substantially by delivering safe and effective radical cure.iii iv

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Section: Chapter 1 Introductionsupporting

confidence: 62%

The Economics of Vivax Malaria Treatment

Devine¹

2018

Preprint

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“…The World Health Organization considers interventions whose cost per qualityadjusted life-year (QALY) gained is less than per capita GDP to be ''very costeffective'' (Bertram et al 2016); Mexico's per capita GDP in 2011 was $10,307.…”

Section: Discussionmentioning

confidence: 99%

The impact of pharmaceutical innovation on cancer mortality in Mexico, 2003–2013

Lichtenberg

2017

Lat Am Econ Rev

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I assess the impact that pharmaceutical innovation had on cancer mortality in Mexico during the period 2003-2013, by investigating whether there were larger declines in the age-standardized mortality rate of cancer sites (breast, lung, colon, etc.) that were subject to more pharmaceutical innovation, controlling for changes in the age-standardized cancer incidence rate. The estimates indicate that new drugs launched during 1991-2001 reduced the age-standardized cancer mortality rate by 16%, i.e., at an average annual rate of about 1.6%. I estimate that

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“…55,56 Recently WHO recommended not using these thresholds, alone, as a decision rule for funding decisions. 57 This systematic review identified a significant association between the conclusions of vaccines cost-effectiveness and pharmaceutical industry sponsorship (p < 0.012). Pharmaceutical industry sponsored studies were significantly more likely to report more favorable results than government or academic sponsored studies.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of health economic evaluations of vaccines in Brazil

Sartori

Rozman

Decimoni

et al. 2017

Human Vaccines & Immunotherapeutics

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Methods: Systematic review of the literature. We searched multiple databases. Two researchers independently selected the studies and extracted the data. The methodological quality of individual studies was evaluated using CHEERS items. Results: Twenty studies were reviewed. The most evaluated vaccines were pneumococcal (25%) and HPV (15%). The most used types of HEE were cost-effectiveness analysis (45%) and cost-utility analysis (20%). The research question and compared strategies were stated in all 20 studies and the target population was clear in 95%. Nevertheless, many studies did not inform the perspective of analysis or data sources. Conclusions: HEE of vaccines in Brazil has increased since 2008. However, the studies still have methodological deficiencies.

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Cost–effectiveness thresholds: pros and cons

Cited by 560 publications

References 31 publications

The Economics of Vivax Malaria Treatment

The Economics of Vivax Malaria Treatment

The impact of pharmaceutical innovation on cancer mortality in Mexico, 2003–2013

A systematic review of health economic evaluations of vaccines in Brazil

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