ORIGINAL_ARTICLE
Introduction to the Special Issue on “The World Health Organization Choosing Interventions That Are Cost-Effective (WHO-CHOICE) Update”
The WHO-CHOICE (World Health Organization CHOosing Interventions that are Cost-Effective) approach is unique in the global health landscape, as it takes a “generalized” approach to cost-effectiveness analysis (CEA) that can be seen as a quantitative assessment of current and future efficiency within a health system. CEA is a critical contribution to the process of priority setting and decision-making in healthcare, contributing to deliberative dialogue processes to select services to be funded. WHO-CHOICE provides regional level estimates of cost-effectiveness, along with tools to support country level analyses. This series provides an update to the methodological approach used in WHO-CHOICE and presents updated cost-effectiveness estimates for 479 interventions. Five papers are presented, the first focusing on methodological updates, followed by three results papers on maternal, newborn and child health; HIV, tuberculosis and malaria; and non- communicable diseases and mental health. The final paper presents a set of example universal health coverage (UHC) benefit packages selected through only a value for money lens, showing that all disease areas have interventions which can fall on the efficiency frontier. Critical for all countries is institutionalizing decisionmaking processes. A UHC benefit package should not be static, as the countries needs and ability to pay change over time. Decisions will need to be continually revised and new interventions added to health benefit packages. This is a vital component of progressive realization, as the package is expanded over time. Developing an institutionalized process ensures this can be done consistently, fairly, and transparently, to ensure an equitable path to UHC.
https://www.ijhpm.com/article_4139_8746f3c196d741b72cbadf8ea3c43a05.pdf
2021-11-01
670
672
10.34172/ijhpm.2021.105
Cost-Effectiveness Analysis
Universal Health Coverage
Benefit Package
Economics
Melanie Y.
Bertram
bertramm@who.int
1
Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
LEAD_AUTHOR
Tessa Tan Torres
Edejer
tantorrest@who.int
2
Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
AUTHOR
Sustainable Development Knowledge Platform. https://sustainabledevelopment.un.org/sdg3. Accessed November 20, 2021.
1
World Health Organization (WHO). Making Fair Choices on the Path to Universal Health Coverage. WHO; 2014.
2
World Health Organization (WHO). Principles of Health Benefit Packages. Geneva: WHO; 2021.
3
Hutubessy R, Chisholm D, Edejer TT. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc. 2003;1(1):8. doi:1186/1478-7547-1-8
4
Do LA, Synnott PG, Ma S, Ollendorf DA. Bridging the gap: aligning economic research with disease burden. BMJ Glob Health. 2021;6(6):e005673. doi:1136/bmjgh-2021-005673
5
Bertram MY, Lauer JA, Stenberg K, Edejer TTT. Methods for the economic evaluation of health care interventions for priority setting in the health system: an update from WHO CHOICE. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2020.244
6
Stenberg K, Watts R, Bertram MY, et al. Cost-effectiveness of interventions to improve maternal, newborn and child health outcomes: a WHO-CHOICE analysis for Eastern sub-Saharan Africa and South-East Asia. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.07
7
Ralaidovy AH, Lauer JA, Pretorius C, Briët OJ, Patouillard E. Priority setting in HIV, tuberculosis, and malaria–new cost-effectiveness results from WHO-CHOICE. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2020.251
8
Bertram MY, Chisholm D, Watts R, Waqanivalu T, Prasad V, Varghese C. Cost-effectiveness of population level and individual level interventions to combat non-communicable disease in Eastern sub-Saharan Africa and South East Asia: a WHO-CHOICE analysis. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.37
9
Bertram MY, Lauer JA, Stenberg K, Ralaidovy AH, Edejer TT. Progressive realisation of universal health coverage in low- and middle-income countries: beyond the "best buys". Int J Health Policy Manag. 2021. doi:34172/ijhpm.2020.245
10
Mauskopf J, Rutten F, Schonfeld W. Cost-effectiveness league tables: valuable guidance for decision makers? Pharmacoeconomics. 2003;21(14):991-1000. doi:2165/00019053-200321140-00001
11
Lauer JA, Rajan D, Bertram MY. Priority setting for universal health coverage: we need to focus both on substance and on process comment on "priority setting for universal health coverage: we need evidence-informed deliberative processes, not just more evidence on cost-effectiveness". Int J Health Policy Manag. 2017;6(10):601-603. doi:15171/ijhpm.2017.06
12
Baltussen R, Jansen MPM, Bijlmakers L, et al. Value assessment frameworks for HTA agencies: the organization of evidence-informed deliberative processes. Value Health. 2017;20(2):256-260. doi:1016/j.jval.2016.11.019
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Daniels N. Accountability for reasonableness. BMJ. 2000;321(7272):1300-1301. doi:1136/bmj.321.7272.1300
14
Glassman A, Giedion U, Smith PC. What's In, What's Out: Designing Benefits for Universal Health Coverage. Brookings Institution Press; 2017.
15
Bertram M, Dhaene G, Edejer TT. Institutionalizing Health Technology Assessment Mechanisms: A How to Guide. World Health Organization; 2021.
16
ORIGINAL_ARTICLE
Methods for the Economic Evaluation of Health Care Interventions for Priority Setting in the Health System: An Update From WHO CHOICE
The World Health Organization’s (WHO’s) Choosing Interventions that are Cost-Effective (CHOICE) programme has been a global leader in the field of economic evaluation, specifically cost-effectiveness analysis for almost 20 years. WHO-CHOICE takes a “generalized” approach to cost-effectiveness analysis that can be seen as a quantitative assessment of current and future efficiency within a health system. This supports priority setting processes, ensuring that health stewards know how to spend resources in order to achieve the highest health gain as one consideration in strategic planning. This approach is unique in the global health landscape. This paper provides an overview of the methodological approach, updates to analytic framework over the past 10 years, and the added value of the WHO-CHOICE approach in supporting decision makers as they aim to use limited health resources to achieve the Sustainable Development Goals (SDGs) by 2030.
https://www.ijhpm.com/article_4004_ef6f0a5e07a8ca5a44fec365381b2e3a.pdf
2021-11-01
673
677
10.34172/ijhpm.2020.244
Cost-Effectiveness Analysis
Economic Evaluation
Health Benefit Package
Melanie Y.
Bertram
bertramm@who.int
1
Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
LEAD_AUTHOR
Jeremy A.
Lauer
lauerj@who.int
2
Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
AUTHOR
Karin
Stenberg
stenbergk@who.int
3
Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
AUTHOR
Tessa Tan Torres
Edejer
tantorrest@who.int
4
Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
AUTHOR
Hutubessy R, Chisholm D, Edejer TT. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc. 2003;1(1):8. doi:10.1186/1478-7547-1-8
1
Lauer JA, Rajan D, Bertram MY. Priority setting for universal health coverage: we need to focus both on substance and on process: comment on "priority setting for universal health coverage: we need evidence-informed deliberative processes, not just more evidence on cost-effectiveness." Int J Health Policy Manag. 2017;6(10):601-603. doi:10.15171/ijhpm.2017.06
2
Griffiths EA, Hendrich JK, Stoddart SD, Walsh SC. Acceptance of health technology assessment submissions with incremental cost-effectiveness ratios above the cost-effectiveness threshold. Clinicoecon Outcomes Res. 2015;7:463-476. doi:10.2147/ceor.s87462
3
Evans DB, Edejer TT, Adam T, Lim SS. Methods to assess the costs and health effects of interventions for improving health in developing countries. BMJ. 2005;331(7525):1137-1140. doi:10.1136/bmj.331.7525.1137
4
Lauer JA, Röhrich K, Wirth H, Charette C, Gribble S, Murray CJ. PopMod: a longitudinal population model with two interacting disease states. Cost Eff Resour Alloc. 2003;1(1):6. doi:10.1186/1478-7547-1-6
5
Salomon JA, Vos T, Hogan DR, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2129-2143. doi:10.1016/s0140-6736(12)61680-8
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United Nations Population Division. World Population Prospects, the 2015 revision. Available from: http://esa.un.org/unpd/wpp/. Published July 2015.
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Drummond M, Sculpher M, Torrance G, O'Brien B, Stoddart G. Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press; 2005.
8
Johns B, Baltussen R, Hutubessy R. Programme costs in the economic evaluation of health interventions. Cost Eff Resour Alloc. 2003;1(1):1. doi:10.1186/1478-7547-1-1
9
Bertram MY, Stenberg K, Brindley C, et al. Disease control programme support costs: an update of WHO-CHOICE methodology, price databases and quantity assumptions. Cost Eff Resour Alloc. 2017;15:21. doi:10.1186/s12962-017-0083-6
10
Jit M, Mibei W. Discounting in the evaluation of the cost-effectiveness of a vaccination programme: a critical review. Vaccine. 2015;33(32):3788-3794. doi:10.1016/j.vaccine.2015.06.084
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Claxton K, Paulden M, Gravelle H, Brouwer W, Culyer AJ. Discounting and decision making in the economic evaluation of health-care technologies. Health Econ. 2011;20(1):2-15. doi:10.1002/hec.1612
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Giving What We Can, Techcnical Working Paper. https://assets.ctfassets.net/dhpcfh1bs3p6/7t4MgiycIceN88BEAeu31E/fdafd35a540bf319bb4a1a483c42fb73/Discount.pdf.
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Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197-2223. doi:10.1016/s0140-6736(12)61689-4
14
Neumann PJ, Anderson JE, Panzer AD, et al. Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures. Gates Open Res. 2018;2:5. doi:10.12688/gatesopenres.12786.2
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Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S. Thresholds for the cost-effectiveness of interventions: alternative approaches. Bull World Health Organ. 2015;93(2):118-124. doi:10.2471/blt.14.138206
16
WHO Commission on Macroeconomics and Health. Report of the WHO Commission on Macroeconomics and Health. Geneva: World Health Organization; 2002:4.
17
Bertram MY, Lauer JA, De Joncheere K, et al. Cost-effectiveness thresholds: pros and cons. Bull World Health Organ. 2016;94(12):925-930. doi:10.2471/blt.15.164418
18
Williams I, Bryan S. Lonely at the top and stuck in the middle? the ongoing challenge of using cost-effectiveness information in priority setting: comment on "use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart diseases in Sweden." Int J Health Policy Manag. 2015;4(3):185-187. doi:10.15171/ijhpm.2015.32
19
ORIGINAL_ARTICLE
Priority Setting in HIV, Tuberculosis, and Malaria – New Cost-Effectiveness Results From WHO-CHOICE
BackgroundThis paper forms part of an update of the World Health Organization Choosing Interventions that are Cost-Effective (WHO-CHOICE) programmes. It provides an assessment of global health system performance during the first decade of the 21st century (2000-2010) with respect to allocative efficiency in HIV, tuberculosis (TB) and malaria control, thereby shining a spotlight on programme development and scale up in these Millennium Development Goal (MDG) priority areas; and examining the cost-effectiveness of selected best-practice interventions and intervention packages commonly in use during that period. MethodsGeneralized cost-effectiveness analysis (GCEA) was used to determine the cost-effectiveness of the selected interventions. Impact modelling was performed using the OpenMalaria platform for malaria and using the Goals and TIME (TB Impact Model and Estimates) models in Spectrum for HIV and TB. All health system costs, regardless of payer, were included and reported in international dollars. Health outcomes are estimated and reported as the gain in healthy life years (HLYs) due to the specific intervention or combination. Analysis was restricted to eastern sub-Saharan Africa and Southeast Asia. ResultsAt the reference year of 2010, commonly used interventions for HIV, TB and malaria were cost-effective, with cost-effectiveness ratios less than I$ 100/HLY saved for virtually all interventions included. HIV, TB and malaria prevention and treatment interventions are highly cost-effective and can be implemented through a phased approach to full coverage to achieve maximum health benefits and contribute to the progressive elimination of these diseases. ConclusionDuring the first decade of the 21st century (2000-2010), the global community has done well overall for HIV, TB, and malaria programmes as regards both economic efficiency and programmatic selection criteria. The role of international assistance, financial and technical, arguably was critical to these successes. As the global community now tackles the challenge of universal health coverage, this analysis can reinforce commitment to Sustainable Development Goal targets but also the importance of continued focus on these critical programme areas.
https://www.ijhpm.com/article_3995_aa2cdb65de434da1d356db22c1b154c8.pdf
2021-11-01
678
696
10.34172/ijhpm.2020.251
Cost-Effectiveness Analysis
HIV
Tuberculosis
Malaria
Priority Setting
Universal Health Coverage
Ambinintsoa H.
Ralaidovy
ralaidovya@who.int
1
World Health Organization (WHO), Geneva, Switzerland
LEAD_AUTHOR
Jeremy Addison
Lauer
jeremy.lauer@strath.ac.uk
2
World Health Organization (WHO), Geneva, Switzerland
AUTHOR
Carel
Pretorius
cpretorius@avenirhealth.org
3
Avenir Health, Glastonbury, CT, USA
AUTHOR
Olivier JT
Briët
o.briet@gmail.com
4
Swiss Tropical and Public Health Institute, Basel, Switzerland
AUTHOR
Edith
Patouillard
patouillarde@who.int
5
World Health Organization (WHO), Geneva, Switzerland
AUTHOR
United Nations. Sustainable development knowledge platform: 3. Ensure healthy lives and promote well-being for all at all ages. https://sdgs.un.org/goals/goal3. Accessed August 14, 2017. Published 2016.
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Hogan DR, Baltussen R, Hayashi C, Lauer JA, Salomon JA. Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries. BMJ. 2005;331(7530):1431-1437. doi:10.1136/bmj.38643.368692.68
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Evans DB, Edejer TT, Adam T, Lim SS. Methods to assess the costs and health effects of interventions for improving health in developing countries. BMJ. 2005;331(7525):1137-1140. doi:10.1136/bmj.331.7525.1137
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Hutubessy R, Chisholm D, Edejer TT. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc. 2003;1(1):8. doi:10.1186/1478-7547-1-8
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Bertram MY, Stenberg K, Brindley C, et al. Disease control programme support costs: an update of WHO-CHOICE methodology, price databases and quantity assumptions. Cost Eff Resour Alloc. 2017;15:21. doi:10.1186/s12962-017-0083-6
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70
ORIGINAL_ARTICLE
Progressive Realisation of Universal Health Coverage in Low- and Middle-Income Countries: Beyond the “Best Buys”
BackgroundWorld Health Organization Choosing Interventions that are Cost-Effective (WHO CHOICE) has been a programme of the WHO for 20 years. In this latest update, we present for the first time a cross programme analysis of the comparative cost-effectiveness of 479 intervention scenarios across 20 disease programmes and risk factors. MethodsThis analysis follows the standard WHO CHOICE approach to generalized cost-effectiveness analysis applied to two regions, Eastern sub-Saharan Africa and Southeast Asia. The scope of the analysis is all interventions included in programme specific WHO CHOICE analyses, using WHO treatment guidelines for major disease areas as the foundation. Costs are measured in 2010 international dollars, and benefits modelled beginning in 2010, or the nearest year for which validated data was available, both for a period of 100 years. ResultsAcross both regions included in the analysis, interventions span multiple orders of magnitude in terms of cost-effectiveness ratios. A health benefit package optimized through a value for money lens incorporates interventions responding to all of the main drivers of disease burden. Interventions delivered through first level clinical and nonclinical services represent the majority of the high impact cost-effective interventions. ConclusionCost-effectiveness is one important criterion when selecting health interventions for benefit packages to progress towards universal health coverage (UHC), but it is not the only criterion and all calculations should be adapted to the local context. To support country decision-makers, WHO CHOICE has developed a downloadable tool to support the development of data for this criterion.
https://www.ijhpm.com/article_4013_b0579dbe432c35fcb67ecae1a36202c9.pdf
2021-11-01
697
705
10.34172/ijhpm.2020.245
Cost-Effectiveness
Economic Evaluation
Efficiency
Universal Health Coverage
Melanie Y.
Bertram
bertramm@who.int
1
Health Systems Governance and Financing, World Health Organization (WHO), Geneva, Switzerland
LEAD_AUTHOR
Jeremy A.
Lauer
lauerj@who.int
2
Health Systems Governance and Financing, World Health Organization (WHO), Geneva, Switzerland
AUTHOR
Karin
Stenberg
stenbergk@who.int
3
Health Systems Governance and Financing, World Health Organization (WHO), Geneva, Switzerland
AUTHOR
Ambinintsoa H.
Ralaidovy
ralaidovya@who.int
4
Science Division, World Health Organization (WHO), Geneva, Switzerland
AUTHOR
Tessa Tan-Torres
Edejer
tantorrest@who.int
5
Health Systems Governance and Financing, World Health Organization (WHO), Geneva, Switzerland
AUTHOR
Lauer JA, Rajan D, Bertram MY. Priority Setting for universal health coverage: we need to focus both on substance and on process: Comment on "priority setting for universal health coverage: we need evidence-informed deliberative processes, not just more evidence on cost-effectiveness." Int J Health Policy Manag. 2017;6(10):601-603. doi:10.15171/ijhpm.2017.06.
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10
Hogan DR, Baltussen R, Hayashi C, Lauer JA, Salomon JA. Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries. BMJ. 2005;331(7530):1431-1437. doi:10.1136/bmj.38643.368692.68
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Evans DB, Edejer TT, Adam T, Lim SS. Methods to assess the costs and health effects of interventions for improving health in developing countries. BMJ. 2005;331(7525):1137-1140. doi:10.1136/bmj.331.7525.1137
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Adam T, Lim SS, Mehta S, et al. Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. BMJ. 2005;331(7525):1107. doi:10.1136/bmj.331.7525.1107
13
Edejer TT, Aikins M, Black R, Wolfson L, Hutubessy R, Evans DB. Cost effectiveness analysis of strategies for child health in developing countries. BMJ. 2005;331(7526):1177. doi:10.1136/bmj.38652.550278.7C
14
Baltussen R, Floyd K, Dye C. Cost effectiveness analysis of strategies for tuberculosis control in developing countries. BMJ. 2005;331(7529):1364. doi:10.1136/bmj.38645.660093.68
15
Ginsberg GM, Lauer JA, Zelle S, Baeten S, Baltussen R. Cost effectiveness of strategies to combat breast, cervical, and colorectal cancer in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e614. doi:10.1136/bmj.e614
16
Ortegón M, Lim S, Chisholm D, Mendis S. Cost effectiveness of strategies to combat cardiovascular disease, diabetes, and tobacco use in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e607. doi:10.1136/bmj.e607
17
Chisholm D, Saxena S. Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e609. doi:10.1136/bmj.e609
18
United Nations Population Division. World Population Prospects: The 2015 Revision. http://esa.un.org/unpd/wpp/. Accessed July 2015. Published 2015.
19
World Health Organization (WHO). Global Health Observatory. http://gamapserver.who.int/gho/interactive_charts/mbd/life_expectancy/atlas.html.
20
Bertram MY, Stenberg K, Brindley C, et al. Disease control programme support costs: an update of WHO-CHOICE methodology, price databases and quantity assumptions. Cost Eff Resour Alloc. 2017;15:21. doi:10.1186/s12962-017-0083-6
21
Serje J, Bertram MY, Brindley C, Lauer JA. Global health worker salary estimates: an econometric analysis of global earnings data. Cost Eff Resour Alloc. 2018;16:10. doi:10.1186/s12962-018-0093-z
22
Stenberg K, Lauer JA, Gkountouras G, Fitzpatrick C, Stanciole A. Econometric estimation of WHO-CHOICE country-specific costs for inpatient and outpatient health service delivery. Cost Eff Resour Alloc. 2018;16:11. doi:10.1186/s12962-018-0095-x
23
Ralaidovy AH, Bachani AM, Lauer JA, Lai T, Chisholm D. Cost-effectiveness of strategies to prevent road traffic injuries in eastern sub-Saharan Africa and Southeast Asia: new results from WHO-CHOICE. Cost Eff Resour Alloc. 2018;16:59. doi:10.1186/s12962-018-0161-4
24
Ralaidovy AH, Gopalappa C, Ilbawi A, Pretorius C, Lauer JA. Cost-effective interventions for breast cancer, cervical cancer, and colorectal cancer: new results from WHO-CHOICE. Cost Eff Resour Alloc. 2018;16:38. doi:10.1186/s12962-018-0157-0
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Bertram MY, Lauer JA, Stenberg K, Edejer TTT. Methods for the economic evaluation of health care interventions for priority setting in the health system: An update from WHO CHOICE. Int J Health Policy Manag. 2020; In Press. doi:10.34172/ijhpm.2020.244
26
Stenberg K, Watts R, Bertram MY, Engesveen K, Maliqi B, Say L, Hutubessy R. Cost-Effectiveness of Interventions to Improve Maternal, Newborn and Child Health Outcomes: A WHO-CHOICE Analysis for Eastern Sub-Saharan Africa and South-East Asia. Int J Health Policy Manag.. 2020; In Press.
27
Ralaidovy AH, Lauer JA, Pretorius C, Briët OJ, Patouillard E. Priority setting in HIV, tuberculosis, and malaria – New cost-effectiveness results from WHO-CHOICE. Int J Health Policy Manag. 2020; In Press. doi:10.34172/ijhpm.2020.251
28
Stenberg K, Hanssen O, Edejer TT, et al. Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries. Lancet Glob Health. 2017;5(9):e875-e887. doi:10.1016/s2214-109x(17)30263-2
29
Bertram MY, Chisholm D, Watts R, Waqanivalu T, Prasad V, Varghese C. Cost-effectiveness of population level and individual level interventions to combat non-communicable disease in Eastern Sub-Saharan Africa and South East Asia: a WHO-CHOICE analysis. Int J Health Pol Manag. 2020; In Press.
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Stenberg K, Hanssen O, Bertram M, et al. Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study. Lancet Glob Health. 2019;7(11):e1500-e1510. doi:10.1016/s2214-109x(19)30416-4
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Rehfuess EA, Stratil JM, Scheel IB, Portela A, Norris SL, Baltussen R. The WHO-INTEGRATE evidence to decision framework version 1.0: integrating WHO norms and values and a complexity perspective. BMJ Glob Health. 2019;4(Suppl 1):e000844. doi:10.1136/bmjgh-2018-000844
35
ORIGINAL_ARTICLE
Cost-Effectiveness of Interventions to Improve Maternal, Newborn and Child Health Outcomes: A WHO-CHOICE Analysis for Eastern Sub-Saharan Africa and South-East Asia
Background Information on cost-effectiveness allows policy-makers to evaluate if they are using currently available resources effectively and efficiently. Our objective is to examine the cost-effectiveness of health interventions to improve maternal, newborn and child health (MNCH) outcomes, to provide global evidence relative to the context of two geographic regions. Methods We consider interventions across the life course from adolescence to pregnancy and for children up to 5 years old. Interventions included are those that fall within the areas of immunization, child healthcare, nutrition, reproductive health, and maternal/newborn health, and for which it is possible to model impact on MNCH mortality outcomes using the Lives Saved Tool (LiST). Generalized cost-effectiveness analysis (GCEA) was used to derive average cost-effectiveness ratios (ACERs) for individual interventions and combinations (packages). Costs were assessed from the health system perspective and reported in international dollars. Health outcomes were estimated and reported as the gain in healthy life years (HLYs) due to the specific intervention or combination. The model was run for 2 regions: Eastern sub-Saharan Africa (SSA-E) and South-East Asia (SEA). Results The World Health Organization (WHO) recommended interventions to improve MNCH are generally considered cost-effective, with the majority of interventions demonstrating ACERs below I$100/HLY saved in the chosen settings (lowand middle-income countries [LMICs]). Best performing interventions are consistent across the two regions, and include family planning, neonatal resuscitation, management of pneumonia and neonatal infection, vitamin A supplementation, and measles vaccine. ACERs below I$100 can be found across all delivery platforms, from community to hospital level. The combination of interventions into packages (such as antenatal care) produces favorable ACERs. Conclusion Within each region there are interventions which represent very good value for money. There are opportunities to gear investments towards high-impact interventions and packages for MNCH outcomes. Cost-effectiveness tools can be used at national level to inform investment cases and overall priority setting processes.
https://www.ijhpm.com/article_4023_e009bce62c2627035b73030fbae9b705.pdf
2021-11-01
706
723
10.34172/ijhpm.2021.07
Cost-Effectiveness
Maternal Health
Child Health
Sub-Saharan Africa
South-East Asia
Karin
Stenberg
stenbergk@who.int
1
Department of Health Systems Governance and Financing, World Health Organization (WHO), Geneva, Switzerland
LEAD_AUTHOR
Rory
Watts
rory.watts@gmail.com
2
School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
AUTHOR
Melanie Y.
Bertram
bertramm@who.int
3
Department of Health Systems Governance and Financing, World Health Organization (WHO), Geneva, Switzerland
AUTHOR
Kaia
Engesveen
engesveenk@who.int
4
Department of Nutrition for Health and Development, World Health Organization (WHO), Geneva, Switzerland
AUTHOR
Blerta
Maliqi
maliqib@who.int
5
Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization (WHO), Geneva, Switzerland
AUTHOR
Lale
Say
sayl@who.int
6
Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
AUTHOR
Raymond
Hutubessy
hutubessyr@who.int
7
Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), Geneva, Switzerland
AUTHOR
World Health Organization (WHO). Trends in Maternal Mortality 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: WHO; 2019.
1
World Health Organization (WHO). MDGs: Progress Made in Health. https://www.who.int/topics/millennium_development_goals/post2015/en/.
2
United Nations. Transforming Our World: The 2030 Agenda for Sustainable Development. United Nations; 2015. https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf.
3
Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427-451. doi:10.1016/s0140-6736(13)60937-x
4
Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1859-1922. doi:10.1016/s0140-6736(18)32335-3
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The Partnership for Maternal, Newborn & Child Health (PMNCH). A Global Review of the Key Interventions Related to Reproductive, Maternal, Newborn and Child Health. PMNCH; 2011.
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Tracking Progress towards Universal Coverage for Reproductive, Newborn and Child Health: The 2017 Report. Washington, DC: United Nations Children’s Fund (UNICEF), World Health Organization (WHO); 2017.
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World Health Organization (WHO), United Nations Development Programme (UNDP). Non-Communicable Disease Prevention and Control: A Guidance Note for Investment Cases. https://apps.who.int/iris/bitstream/handle/10665/311180/WHO-NMH-NMA-19.95-eng.pdf?sequence=1. Accessed December 20, 2020.
8
World Bank Group. GFF Country Implementation Guidelines. https://www.globalfinancingfacility.org/gff-country-implementation-guidelines. Accessed September 20, 2019. Published 2019.
9
Bertram MY, Lauer JA, Stenberg K, Edejer TT. Methods for the Economic evaluation of health care interventions for priority setting in the health system: an update from WHO-CHOICE. Int J Health Policy Manag. 2021; In Press. doi:10.34172/ijhpm.2020.244
10
Bertram MY, Chisholm D, Watts R, Waqanivalu T, Varghese C, Prasad V. Cost-effectiveness of population level and individual level interventions to combat Non-Communicable Disease in Eastern sub-Saharan Africa and South East Asia: a WHO-CHOICE analysis. Int J Health Policy Manag. 2021; Forthcoming.
11
Ralaidovy AH, Lauer JA, Pretorius C, Briët OJ, Patouillard E. Priority setting in HIV, tuberculosis, and malaria–new cost-effectiveness results from WHO-CHOICE. Int J Health Policy Manag. 2021; In Press. doi:10.34172/ijhpm.2020.251
12
Bertram MY, Lauer JA, Stenberg K, Ralaidovy AH, Edejer TT. Progressive realisation of universal health coverage in low- and middle-income countries: beyond. Int J Health Policy Manag. 2021; Forthcoming.
13
Adam T, Lim SS, Mehta S, et al. Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. BMJ. 2005;331(7525):1107. doi:10.1136/bmj.331.7525.1107
14
Edejer TT, Aikins M, Black R, Wolfson L, Hutubessy R, Evans DB. Cost effectiveness analysis of strategies for child health in developing countries. BMJ. 2005;331(7526):1177. doi:10.1136/bmj.38652.550278.7C
15
World Health Organization (WHO). WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. Geneva: WHO; 2016.
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World Health Organization (WHO). WHO Guidelines on Maternal, Newborn, Child and Adolescent Health. WHO; 2020. https://www.who.int/maternal_child_adolescent/guidelines/en/. Accessed February 1, 2020.
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Walker N, Tam Y, Friberg IK. Overview of the Lives Saved Tool (LiST). BMC Public Health. 2013;13(Suppl 3):S1. doi:10.1186/1471-2458-13-s3-s1
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USAID. FamPlan - A Computer Program for Projecting Family Planning Requirements. https://lse.rl.talis.com/items/33154920-B849-F215-1A20-E8C4D1B39D2B.html. Accessed October 22, 2019.
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Stover J, McKinnon R, Winfrey B. Spectrum: a model platform for linking maternal and child survival interventions with AIDS, family planning and demographic projections. Int J Epidemiol. 2010;39(Suppl 1):i7-10. doi:10.1093/ije/dyq016
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Salomon JA, Vos T, Hogan DR, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2129-2143. doi:10.1016/s0140-6736(12)61680-8
22
Avenir Health. OneHealth Tool. https://www.avenirhealth.org/software-onehealth.php.
23
Bertram MY, Stenberg K, Brindley C, et al. Disease control programme support costs: an update of WHO-CHOICE methodology, price databases and quantity assumptions. Cost Eff Resour Alloc. 2017;15:21. doi:10.1186/s12962-017-0083-6
24
Stenberg K, Lauer JA, Gkountouras G, Fitzpatrick C, Stanciole A. Econometric estimation of WHO-CHOICE country-specific costs for inpatient and outpatient health service delivery. Cost Eff Resour Alloc. 2018;16:11. doi:10.1186/s12962-018-0095-x
25
Serje J, Bertram MY, Brindley C, Lauer JA. Global health worker salary estimates: an econometric analysis of global earnings data. Cost Eff Resour Alloc. 2018;16:10. doi:10.1186/s12962-018-0093-z
26
Horton S, Levin C. Cost-effectiveness of interventions for reproductive, maternal, neonatal, and child health. In: Black RE, Laxminarayan R, Temmerman M, Walker N, eds. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington, DC: The International Bank for Reconstruction and Development, The World Bank; 2016.
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World Health Organization (WHO). Essential Nutrition Actions: Mainstreaming Nutrition Through the Life-Course. WHO; 2019.
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Institute for Health Metrics and Evaluation (IHME). Financing Global Health 2018: Countries and Programs in Transition. Seattle, WA: IHME, 2019.
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Bhutta ZA, Das JK, Bahl R, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384(9940):347-370. doi:10.1016/s0140-6736(14)60792-3
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Clark H, Coll-Seck AM, Banerjee A, et al. A future for the world's children? a WHO-UNICEF-Lancet Commission. Lancet. 2020;395(10224):605-658. doi:10.1016/s0140-6736(19)32540-1
32
ORIGINAL_ARTICLE
Cost-Effectiveness of Population Level and Individual Level Interventions to Combat Non-communicable Disease in Eastern Sub-Saharan Africa and South East Asia: A WHO-CHOICE Analysis
Background To determine the health system costs and health-related benefits of interventions for the prevention and control of non-communicable diseases (NCDs), including mental health disorders, for the purpose of identifying the most cost-effective intervention options in support of global normative guidance on the best-buy interventions for NCDs. In addition, tools are developed to allow country contextualisation of the analyses to support local priority setting exercises. Methods This analysis follows the standard WHO-CHOICE (World Health Organization-Choosing Interventions that are Cost-Effective) approach to generalized cost-effectiveness analysis applied to two regions, Eastern sub-Saharan Africa and South-East Asia. The scope of the analysis is all NCD and mental health interventions included in WHO guidelines or guidance documents for which the health impact of the intervention is able to be identified and attributed. Costs are measured in 2010 international dollars, and benefits modelled beginning in 2010, both for a period of 100 years. Results There are many interventions for NCD prevention and management that are highly cost-effective, generating one year of healthy life for less than Int. $100. These interventions include tobacco and alcohol control policies such as taxation, voluntary and legislative actions to reduce sodium intake, mass media campaigns for reducing physical activity, and treatment options for cardiovascular disease (CVD), cervical cancer and epilepsy. In addition a number of interventions fall just outside this range, including breast cancer, depression and chronic lung disease treatment. Conclusion Interventions that represent good value for money, are technically feasible and are delivered for a low per-capita cost, are available to address the rapid rise in NCDs in low- and middle-income countries. This paper also describes a tool to support countries in developing NCD action plans.
https://www.ijhpm.com/article_4056_c7eacd1bd932f1db3550f5930ff5d931.pdf
2021-11-01
724
733
10.34172/ijhpm.2021.37
Cost-Effectiveness Analysis
Economic Evaluation
Best-Buys
Non-communicable Disease
Mental Health
NCD
Melanie Y.
Bertram
bertramm@who.int
1
Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
LEAD_AUTHOR
Daniel
Chisholm
chisholmd@who.int
2
Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
AUTHOR
Rory
Watts
rory.watts@uwa.edu.au
3
Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
AUTHOR
Temo
Waqanivalu
waqanivalut@who.int
4
Department of Prevention of Non-Communicable Diseases, World Health Organization, Geneva, Switzerland
AUTHOR
Vinayak
Prasad
prasadvi@who.int
5
Department of Prevention of Non-Communicable Diseases, World Health Organization, Geneva, Switzerland
AUTHOR
Cherian
Varghese
varghesec@who.int
6
Department of Management of Non Communicable Diseases, Violence and Injury, World Health Organization, Geneva, Switzerland
AUTHOR
World Health Organization. Global Health Observatory. http://www.who.int/gho/ncd/mortality_morbidity/en/. Accessed July 18, 2017.
1
World Health Organization. Global Health Observatory. http://gamapserver.who.int/gho/interactive_charts/mbd/life_expectancy/atlas.html.
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World Health Organization (WHO). Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2015 global survey. In: Riley L, Cowan M, eds. Geneva, Switzerland: WHO; 2016.
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12
Bertram MY, Lauer JA, De Joncheere K, et al. Cost-effectiveness thresholds: pros and cons. Bull World Health Organ. 2016;94(12):925-930. doi:10.2471/blt.15.164418
13
Ortegón M, Lim S, Chisholm D, Mendis S. Cost effectiveness of strategies to combat cardiovascular disease, diabetes, and tobacco use in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e607. doi:10.1136/bmj.e607
14
Chisholm D, Saxena S. Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e609. doi:10.1136/bmj.e609
15
Ginsberg GM, Lauer JA, Zelle S, Baeten S, Baltussen R. Cost effectiveness of strategies to combat breast, cervical, and colorectal cancer in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e614. doi:10.1136/bmj.e614
16
Hutubessy R, Chisholm D, Edejer TT. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc. 2003;1(1):8. doi:10.1186/1478-7547-1-8
17
Bertram MY, Lauer JA, Stenberg K, Edejer TTT. Methods for the economic evaluation of health care interventions for priority setting in the health system: an update from WHO CHOICE. Int J Health Policy Manag. 2021. doi:10.34172/ijhpm.2020.244
18
Salomon JA, Vos T, Hogan DR, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2129-2143. doi:10.1016/s0140-6736(12)61680-8
19
Bertram MY, Stenberg K, Brindley C, et al. Disease control programme support costs: an update of WHO-CHOICE methodology, price databases and quantity assumptions. Cost Eff Resour Alloc. 2017;15:21. doi:10.1186/s12962-017-0083-6
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Stanciole AE, Ortegón M, Chisholm D, Lauer JA. Cost effectiveness of strategies to combat chronic obstructive pulmonary disease and asthma in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e608. doi:10.1136/bmj.e608
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Zelle SG, Vidaurre T, Abugattas JE, et al. Cost-effectiveness analysis of breast cancer control interventions in Peru. PLoS One. 2013;8(12):e82575. doi:10.1371/journal.pone.0082575
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Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197-2223. doi:10.1016/s0140-6736(12)61689-4
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World Health Organization (WHO). ‘Best Buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Updated (2017) Appendix 3 of the Global Action Plan for the prevention and control of noncommunicable diseases 2013-2020. WHO; 2017.
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Stenberg K, Hanssen O, Edejer TT, et al. Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries. Lancet Glob Health. 2017;5(9):e875-e887. doi:10.1016/s2214-109x(17)30263-2
32