Cost-Effectivess in Low- and Middle-Income Countries: A Review of the Debates Surrounding Decision Rules

Shillcutt, Samuel D.; Walker, Damian; Goodman, Catherine; Mills, Anne

doi:10.2139/ssrn.995045

Cited by 46 publications

(68 citation statements)

References 88 publications

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“…DALYs) are established, based around the average income of individuals within the society. This approach may be interpreted as reflecting an implied human capital method [6] or that individuals are entitled to their 'fair share' of a nation's wealth [7].…”

Section: The History Of Threshold Creation In Lmicsmentioning

confidence: 99%

“…They have also been acknowledged as often being too high in the context of local healthcare budgets [6], leading to a situation where programmes are deemed 'cost effective' yet are unable to be implemented. It may be that they help to place an upper bound on what is deemed 'cost effective', helping decision makers to avoid allocation of resources to interventions that exceed these relatively high thresholds.…”

Section: What Could Be a Way Forward?mentioning

confidence: 99%

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

2014

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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.

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Section: The History Of Threshold Creation In Lmicsmentioning

confidence: 99%

Section: What Could Be a Way Forward?mentioning

confidence: 99%

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

2014

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“…To examine the efficiency/equity trade-offs present in decision making and to obtain a measure of their magnitude, 3 DALY was chosen to define the cost-effectiveness threshold in this study, since the same standardized questionnaire was used previously in lower and middle income countries such as Brazil, Cuba, Nepal, and Uganda [24], where cost-effectiveness thresholds are mostly set by DALYs [32]. 4 Norwegian and Austrian data were presented separately in previous studies [10,12].…”

Section: Modelmentioning

confidence: 99%

Comparative analysis of decision maker preferences for equity/efficiency attributes in reimbursement decisions in three European countries

et al. 2015

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2 AbstractBackground: In addition to cost-effectiveness, national guidelines often include other factors in reimbursement decisions. However, weights attached to these are rarely quantified, thus decisions may strongly depend on decision-maker preferences.Objective: To explore the preferences of policymakers and healthcare professionals involved in the decision-making process for different efficiency and equity attributes of interventions and analyse crosscountry differences.Method: Discrete choice experiments (DCEs) were carried out in Austria, Hungary, and Norway with policymakers and other professionals working in the health industry (N=153 respondents). Interventions were described in terms of different efficiency and equity attributes (severity of disease, target age of the population and willingness to subsidize others, potential number of beneficiaries, individual health benefit, and cost-effectiveness). Parameter estimates from the DCE are used to calculate the probability of choosing a healthcare intervention with different characteristics, and to rank different equity and efficiency attributes according to their importance.Results: In all three countries, cost-effectiveness, individual health benefit and severity of the disease are significant and equally important determinants of decisions. All countries show preferences for interventions targeting young and middle age population compared to those targeting population over 60. However, decision-makers in Austria and Hungary show preferences more oriented to efficiency than equity, while those in Norway show equal preferences for equity and efficiency attributes.Conclusion: We find that factors other than cost-effectiveness seem to play an equally important role in decision-making. We also find evidence of cross-country differences in the weight of efficiency and equity attributes.

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“…31 Some of the fundamental barriers to such a practice may include variation in disease burden; epidemiology; the potentially different values and expectations stakeholders place on health services, which directly influence their willingness to pay and acceptability thresholds; and the degree to which there is a defined regulatory structure for the healthcare system, in terms of insurance coverage, payers involved, payment and reimbursement mechanisms, and pricing practices. 3,32 Specific guidelines pertinent to a developing nation thus need to be conceptualized and developed in the light of the different aspects of its health system's capacity, available resources, societal needs and priorities, and the structure through which pharmacoeconomics can be used to inform decision making.…”

Section: Recommendationsmentioning

confidence: 99%

Pharmacoeconomic Education in Egyptian Schools of Pharmacy

Soliman

Hussein

Abdulhalim

2013

American Journal of Pharmaceutical Education

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Objective. To investigate the status of pharmacoeconomics education in Egyptian schools of pharmacy and compile and construct recommendations on how Egypt and similar countries could improve their educational infrastructure in pharmacoeconomics. Methods. A modified version of a published survey instrument was sent to all schools of pharmacy in Egypt (n5 24). The data were assessed to identify associations between offering pharmacoeconomics education and school characteristics. Results. Usable responses were obtained from 20 schools (response rate: 83%). Only 7 schools offered pharmacoeconomics education, with a median of 20 teaching hours per semester. Among respondents, 4 schools had instructors with some training in pharmacoeconomics and only 1 school had a faculty member with PhD-level training. Only 4 schools offered graduate-level courses in pharmacoeconomics. Eight additional schools expressed interest in teaching pharmacoeconomics in the near future. Having 1 or more faculty members with training in pharmacoeconomics was significantly associated with offering pharmacoeconomics education (p 5 0.03). Conclusions. Pharmacoeconomics education in Egypt is still in its infancy and there exists a unique opportunity for well-trained instructors and researchers to fill this gap. Providing structured pharmacoeconomics education to student pharmacists, researchers, and stakeholders can help countries establish an integrated scientific community that can start applying pharmacoeconomic evidence to healthcare decision-making.

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Cost-Effectivess in Low- and Middle-Income Countries: A Review of the Debates Surrounding Decision Rules

Cited by 46 publications

References 88 publications

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

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

Comparative analysis of decision maker preferences for equity/efficiency attributes in reimbursement decisions in three European countries

Pharmacoeconomic Education in Egyptian Schools of Pharmacy

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