Title |
Thresholds for the cost–effectiveness of interventions: alternative approaches
|
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Published in |
Bulletin of the World Health Organization, December 2014
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DOI | 10.2471/blt.14.138206 |
Pubmed ID | |
Authors |
Elliot Marseille, Bruce Larson, Dhruv S Kazi, James G Kahn, Sydney Rosen |
Abstract |
Many countries use the cost-effectiveness thresholds recommended by the World Health Organization's Choosing Interventions that are Cost-Effective project (WHO-CHOICE) when evaluating health interventions. This project sets the threshold for cost-effectiveness as the cost of the intervention per disability-adjusted life-year (DALY) averted less than three times the country's annual gross domestic product (GDP) per capita. Highly cost-effective interventions are defined as meeting a threshold per DALY averted of once the annual GDP per capita. We argue that reliance on these thresholds reduces the value of cost-effectiveness analyses and makes such analyses too blunt to be useful for most decision-making in the field of public health. Use of these thresholds has little theoretical justification, skirts the difficult but necessary ranking of the relative values of locally-applicable interventions and omits any consideration of what is truly affordable. The WHO-CHOICE thresholds set such a low bar for cost-effectiveness that very few interventions with evidence of efficacy can be ruled out. The thresholds have little value in assessing the trade-offs that decision-makers must confront. We present alternative approaches for applying cost-effectiveness criteria to choices in the allocation of health-care resources. |
X Demographics
Geographical breakdown
Country | Count | As % |
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Unknown | 4 | 100% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 4 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 7 | <1% |
United States | 3 | <1% |
Bangladesh | 1 | <1% |
Netherlands | 1 | <1% |
South Africa | 1 | <1% |
Colombia | 1 | <1% |
Spain | 1 | <1% |
Austria | 1 | <1% |
Unknown | 802 | 98% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 193 | 24% |
Researcher | 133 | 16% |
Student > Ph. D. Student | 87 | 11% |
Student > Bachelor | 54 | 7% |
Other | 48 | 6% |
Other | 142 | 17% |
Unknown | 161 | 20% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 230 | 28% |
Economics, Econometrics and Finance | 83 | 10% |
Nursing and Health Professions | 66 | 8% |
Social Sciences | 54 | 7% |
Pharmacology, Toxicology and Pharmaceutical Science | 36 | 4% |
Other | 144 | 18% |
Unknown | 205 | 25% |