Determining the efficiency path to universal health coverage: cost-effectiveness thresholds for 174 countries based on growth in life expectancy and health expenditures

Andrés, Paúl; Drummond, Michael; Palacios, Alfredo; García-Martí, Sebastián; Augustovski, Federico

doi:10.1016/s2214-109x(23)00162-6

Cited by 58 publications

(30 citation statements)

References 19 publications

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“…First, the corrected WTP per QALY values excluding outliers align well with the reference values used by the Dutch Healthcare institute, ranging from zero (for very mild diseases) via €20,000 and €50,000 to €80,000 in case of very severe illnesses—where severity is expressed in terms of proportional shortfall (Reckers‐Droog et al., 2018). Second, our estimates are also fairly similar to estimations of the marginal cost‐effectiveness of current spending in the healthcare sector, which was estimated to be around €41,000 per QALY in the base case scenario (Van Baal et al., 2019) as well as estimates based on health expenditures per capita and life expectancy at birth (US$47,122 per QALY; Pichon‐Riviere et al., 2023).…”

Section: Soc Sii N Wtp Per Qaly Wtp Per Qaly Wtp Per Qaly N Wtp Per Q...supporting

confidence: 81%

Correction to “Valuing QALY gains by applying a societal perspective”

2023

Health Economics

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Section: Soc Sii N Wtp Per Qaly Wtp Per Qaly Wtp Per Qaly N Wtp Per Q...supporting

confidence: 81%

Correction to “Valuing QALY gains by applying a societal perspective”

2023

Health Economics

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“…Third, our valuation of QALY losses assumes a single willingness-to-pay threshold (GDP per capita). In practice, this threshold is not universal, 30 and in the United States, some recommended vaccinations exceed WHO cost-effectiveness thresholds (e.g., serogroup B meningococcal vaccine 31 ). Fourth, our estimates are based on non-PCV20 serotypes targeted by PCV24/31 and we did not compare burdens from PCV24/31 and PCV15 serotypes, although differences would be expected to be even greater than those observed in our study.…”

Section: Discussionmentioning

confidence: 99%

Health-economic burden attributable to novel serotypes in candidate 24- and 31-valent pneumococcal conjugate vaccines

King,

Lewnard

2024

Preprint

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Background: Next-generation pneumococcal vaccines currently in clinical trials include 24- and 31-valent pneumococcal conjugate vaccines (PCV24, PCV31), which aim to prevent upper-respiratory carriage and disease involving the targeted serotypes. We aimed to estimate the comprehensive health-economic burden associated with acute respiratory infections (ARIs) and invasive pneumococcal disease (IPD) attributable to PCV24- and PCV31-additional (non-PCV20) serotypes in the United States. Methods: We multiplied all-cause incidence rate estimates for acute otitis media (AOM), sinusitis, and non-bacteremic pneumonia by estimates of the proportions of each of these conditions attributable to pneumococci and the proportions of pneumococcal infections involving PCV24- and PCV31-additional serotypes. We obtained serotype-specific IPD incidence rates from US Active Bacterial Core surveillance data. We accounted for direct medical and non-medical costs associated with each condition to estimate resulting health-economic burden. Non-medical costs included missed work and lost quality-adjusted life years due to death and disability. Results: The health-economic burden of PCV24-additional serotypes totaled $1.3 billion ($1.1-1.7b) annually in medical and non-medical costs, comprised of $0.9b ($0.7-1.2b) due to ARIs and $0.4b ($0.3-0.5b) due to IPD. For PCV31-additional serotypes, medical and non-medical costs totaled $7.5b ($6.6-8.6b) annually, with $5.5b ($4.7-6.6b) due to ARIs and $1.9b ($1.8-2.1b) due to IPD. The largest single driver of costs was non-bacteremic pneumonia, particularly in adults aged 50-64 and ≥65 years. Conclusions: Additional serotypes in PCV24 and PCV31, especially those included in PCV31, account for substantial health-economic burden in the United States.

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“…Although most previous studies adopted the one to three times’ GDP/capita threshold first proposed by the WHO, 16,29,30 the WHO has since distanced itself from that threshold. A recent publication used a new approach to estimating country‐specific thresholds and suggested a range of 0.14 to 1.34 times the GDP/capita for a list of selected LMICs shown in the body of the manuscript, and 0.14 to 0.65 times the GDP/capita for low‐income countries, with thresholds 0.53, 0.38 and 0.17 times the GDP/Capita suggested for Zimbabwe, Zambia and Uganda, respectively 31 . Because a set of universally endorsed, country‐specific, cost‐effectiveness thresholds do not yet exist, no particular threshold was selected for this analysis to avoid bias and controversy.…”

Section: Discussionmentioning

confidence: 99%

“…A recent publication used a new approach to estimating country-specific thresholds and suggested a range of 0.14 to 1.34 times the GDP/ capita for a list of selected LMICs shown in the body of the manuscript, and 0.14 to 0.65 times the GDP/capita for low-income countries, with thresholds 0.53, 0.38 and 0.17 times the GDP/Capita suggested for Zimbabwe, Zambia and Uganda, respectively. 31 Because a set of universally endorsed, country-specific, costeffectiveness thresholds do not yet exist, no particular threshold was selected for this analysis to avoid bias and controversy. However, stringent thresholds such as those recently published will render childhood cancer treatment not cost-effective in most scenarios.…”

Section: Costing Categoriesmentioning

confidence: 99%

Addressing the gap in health economics data to support national cancer control plans in low‐ and middle‐income countries: The Childhood Cancers Budgeting Rapidly to Incorporate Disadvantaged Groups for Equity (CC‐BRIDGE) tool

Bolous,

Chokwenda‐Makore,

Bonilla

et al. 2023

Cancer

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BackgroundNational cancer control plans (NCCPs) are complex public health programs that incorporate evidence‐based cancer control strategies to improve health outcomes for all individuals in a country. Given the scope of NCCPs, small and vulnerable populations, such as patients with childhood cancer, are often missed. To support planning efforts, a rapid, modifiable tool was developed that estimates a context‐specific national budget to fund pediatric cancer programs, provides 5‐year scale‐up scenarios, and calculates annual cost‐effectiveness.MethodsThe tool was codeveloped by teams of policymakers, clinicians, and public health advocates in Zimbabwe, Zambia, and Uganda. The 11 costing categories included real‐world data, modeled data, and data from the literature. A base‐case and three 5‐year scale‐up scenarios were created using modifiable inputs. The cost‐effectiveness of the disability‐adjusted life years averted was calculated. Results were compared with each country’s projected gross domestic product per capita for 2022 through 2026.ResultsThe number of patients/total budget for year 1 was 250/$1,109,366 for Zimbabwe, 280/$1,207,555 for Zambia, and 1000/$2,277,397 for Uganda. In year 5, these values were assumed to increase to 398/$5,545,445, 446/$4,926,150, and 1594/$9,059,331, respectively. Base‐case cost per disability‐adjusted life year averted/ratio to gross domestic product per capita for year 1, assuming 20% survival, was: $807/0.5 for Zimbabwe, $785/0.7 for Zambia, and $420/0.5 for Uganda.ConclusionsThis costing tool provided a framework to forecast a budget for childhood‐specific cancer services. By leveraging minimal primary data collection with existing secondary data, local teams obtained rapid results, ensuring that childhood cancer budgeting is not neglected once in every 5 to 6 years of planning processes.

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Determining the efficiency path to universal health coverage: cost-effectiveness thresholds for 174 countries based on growth in life expectancy and health expenditures

Cited by 58 publications

References 19 publications

Correction to “Valuing QALY gains by applying a societal perspective”

Correction to “Valuing QALY gains by applying a societal perspective”

Health-economic burden attributable to novel serotypes in candidate 24- and 31-valent pneumococcal conjugate vaccines

Addressing the gap in health economics data to support national cancer control plans in low‐ and middle‐income countries: The Childhood Cancers Budgeting Rapidly to Incorporate Disadvantaged Groups for Equity (CC‐BRIDGE) tool

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