International Journal of Health Policy and Management

International Journal of Health Policy and Management

Selecting Cost-Effectiveness Methods for Health Benefits Package Design: A Systematic Approach

Document Type : Original Article

Authors
Cassandra Nemzoff 1, 2
Sedona Sweeney 1
Rob Baltussen 3
Anna Vassall 1
1 London School of Hygiene and Tropical Medicine, London, UK
2 Center for Global Development, Washington, DC, USA
3 Radboud University Medical Center, Nijmegen, The Netherlands
10.34172/ijhpm.8562
Abstract
Background 
Cost-effectiveness (CE) is a common prioritization criterion in health benefits package (HBP) design. However, to assess CE is a time- and data-demanding process, so most HBP exercises rely wholly or partially on global evidence. Extensive investment has been made in analyses, models, and tools to support cost-effectiveness analyses (CEAs) for HBPs. However, little attention has been paid to how national HBP assessors should both understand and select CE estimates. A structured, national process to select assessment methods is essential for ensuring the accuracy, ownership, and transparency of HBP design. This can be supported by “adaptive” health technology assessment (aHTA) principles, which focus on structured methodological choices based on the time, data, and capacity available. The objective of this paper was to apply aHTA framing to CEA methods selection for HBPs, and to make recommendations on how countries may consider systematically making these choices going forward.
 
Methods 
We first reviewed the definitions and categorization of different aHTA methods. We then conducted a scoping review of previous HBP assessments to understand how CEA methods used in HBPs fit into the aHTA framework, and a follow-up survey of authors to fill gaps. Results of the literature review and survey were interpreted and narratively synthesized.
 
Results 
We found that previous HBP assessments used four aHTA methods, sometimes simultaneously: expert opinion (n = 3/20), review (n = 12/20), model adaptation (n = 6/20), and new model (n = 2/20). The literature review and survey found that aHTA methods for HBPs take between 1-13 months; require different data sources depending on the method(s) used; and generally, require capacity in health economics, medicine, public health, and CE modelling. We supplement our report with a discussion of key considerations for methods selection.
 
Conclusion 
Trading off time, data, and capacity needs for different CE assessment methods can help to support structured, local design of HBP assessments.
Keywords
Health Benefits Package
Health Technology Assessment
Economic Evaluation
Cost-Effectiveness
  1. World Health Organization (WHO). Health Benefits Packages Survey 2020/2021. WHO; 2021.
  2. Muir JM, Radhakrishnan A, Freitag A, Ozer Stillman I, Sarri G. Reconstructing the value puzzle in health technology assessment: a pragmatic review to determine which modelling methods can account for additional value elements. Front Pharmacol. 2023;14:1197259. doi:3389/fphar.2023.1197259
  3. Baltussen R, Surgey G, Vassall A, et al. The use of cost-effectiveness analysis for health benefit package design - should countries follow a sectoral, incremental or hybrid approach? Cost Eff Resour Alloc. 2023;21(1):75. doi:1186/s12962-023-00484-2
  4. Murray CJ, Evans DB, Acharya A, Baltussen RM. Development of WHO guidelines on generalized cost-effectiveness analysis. Health Econ. 2000;9(3):235-251. doi:1002/(sici)1099-1050(200004)9:3<235::aid-hec502>3.0.co;2-o
  5. Merlin T, Tamblyn D, Ellery B. What's in a name? Developing definitions for common health technology assessment product types of the International Network of Agencies for Health Technology Assessment (INAHTA). Int J Technol Assess Health Care. 2014;30(4):430-437. doi:1017/s0266462314000543
  6. Nemzoff C, Shah HA, Heupink LF, et Adaptive health technology assessment: a scoping review of methods. Value Health. 2023;26(10):1549-1557. doi:10.1016/j.jval.2023.05.017
  7. CEA Registry - Center for the Evaluation of Value and Risk in Health. 2023. https://cevr.tuftsmedicalcenter.org/databases/cea-registry. Accessed November 23, 2020.
  8. Bertram MY, Edejer TTT. Introduction to the special issue on "The World Health Organization choosing interventions that are cost-effective (WHO-CHOICE) update". Int J Health Policy Manag. 2021;10(11):670-672. doi:34172/ijhpm.2021.105
  9. Horton S, Gelband H, Jamison D, Levin C, Nugent R, Watkins D. Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness. PLoS One. 2017;12(8):e0182951. doi:1371/journal.pone.0182951
  10. Rosettie KL, Joffe JN, Sparks GW, et al. Cost-effectiveness of HPV vaccination in 195 countries: a meta-regression analysis. PLoS One. 2021;16(12):e0260808. doi:1371/journal.pone.0260808
  11. Janko MM, Joffe J, Michael D, et al. Cost-effectiveness of rotavirus vaccination in children under five years of age in 195 countries: a meta-regression analysis. Vaccine. 2022;40(28):3903-3917. doi:1016/j.vaccine.2022.05.042
  12. Earl L, Michael D, Janko MM, et al. Cost-Effectiveness of Interventions for HIV/AIDS, Malaria, Syphilis, and Tuberculosis in 128 Countries: A Meta-Regression Approach. IHEA;
  13. Mbau R, Vassall A, Gilson L, Barasa E. Factors influencing institutionalization of health technology assessment in Kenya. BMC Health Serv Res. 2023;23(1):681. doi:1186/s12913-023-09673-4
  14. Kwete X, Tang K, Chen L, et al. Decolonizing global health: what should be the target of this movement and where does it lead us? Glob Health Res Policy. 2022;7(1):3. doi:1186/s41256-022-00237-3
  15. Baker P, Barasa E, Chalkidou K, et al. International partnerships to develop evidence-informed priority setting institutions: ten years of experience from the International Decision Support Initiative (iDSI). Health Syst Reform. 2023;9(3):2330112. doi:1080/23288604.2024.2330112
  16. World Health Organization (WHO). Principles of Health Benefit Packages. WHO; 2021.
  17. Fusch PI, Ness LR. Are we there yet? Data saturation in qualitative research. Qual Rep. 2015;20(9):1408-1416. doi:46743/2160-3715/2015.2281
  18. Welte R, Feenstra T, Jager H, Leidl R. A decision chart for assessing and improving the transferability of economic evaluation results between countries. Pharmacoeconomics. 2004;22(13):857-876. doi:2165/00019053-200422130-00004
  19. Downey L, Chalkidou K, Cluzeau F, Mehndiratta A, Culyer A. The International Decision Support Initiative (iDSI) Health Technology Assessment capacity questionnaire. F1000Res. 2018;7(325):325. doi:7490/f1000research.1115311.1
  20. Disease Control Priorities. 3rd ed. 2017. https://dcp-3.org/. Accessed June 1, 2022.
  21. 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;10(11):678-696. doi:34172/ijhpm.2020.251
  22. 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;10(11):706-723. doi:34172/ijhpm.2021.07
  23. 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;10(11):724-733. doi:34172/ijhpm.2021.37
  24. UHC Compendium. 2024. https://www.who.int/universal-health-coverage/compendium. Accessed June 1, 2022.
  25. International Classification of Health Interventions (ICHI). 2024. https://icd.who.int/dev11/l-ichi/en. Accessed April 9, 2024.
  26. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007;7:16. doi:1186/1472-6947-7-16
  27. Gray AM, Wilkinson T. Economic evaluation of healthcare interventions: old and new directions. Oxf Rev Econ Policy. 2016;32(1):102-121. doi:1093/oxrep/grv020
  28. Megiddo I, Blair S, Sabei D, Ruiz F, Morton AD. Evaluation framework study assessing the role, applicability and adherence to good practice of planning support tools for allocation of development aid for health in low-income and middle-income countries. BMJ Open. 2023;13(7):e069590. doi:1136/bmjopen-2022-069590
  29. World Bank. World Development Report 1993: Investing in Health. Washington, DC: World Bank; 1993. doi:1596/0-1952-0890-0
International Journal of Health Policy and Management
Volume 14, Issue 1
2025
Pages 1-9

XML
PDF 649.48 K
Supplementary File
(IJHPM does not take responsibility for any information provided in the supplementary files.)
Nemzoff-Supple-File-1-IJHPM.xlsx

  • Received Date 29 April 2024
  • Revised Date 01 November 2024
  • Accepted Date 04 March 2025
  • First Published Date 05 March 2025
  • Published Date 01 December 2025