Introduction to the Special Issue on “The World Health Organization Choosing Interventions That Are Cost-Effective (WHO-CHOICE) Update”

Document Type : Editorial

Authors

Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland

Abstract

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.

Keywords


  1. Sustainable Development Knowledge Platform. https://sustainabledevelopment.un.org/sdg3. Accessed November 20, 2021.
  2. World Health Organization (WHO). Making Fair Choices on the Path to Universal Health Coverage. WHO; 2014.
  3. World Health Organization (WHO). Principles of Health Benefit Packages. Geneva: WHO; 2021.
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. Daniels N. Accountability for reasonableness. BMJ. 2000;321(7272):1300-1301. doi:1136/bmj.321.7272.1300
  15. Glassman A, Giedion U, Smith PC. What's In, What's Out: Designing Benefits for Universal Health Coverage. Brookings Institution Press; 2017.
  16. Bertram M, Dhaene G, Edejer TT. Institutionalizing Health Technology Assessment Mechanisms: A How to Guide. World Health Organization; 2021.