Abstract
In assessing the cost-effectiveness of an intervention, the interpretation and handling of uncertainties of the traditional summary measure, the Incremental Cost Effectiveness Ratio (ICER), can be problematic. This is particularly the case with strategies towards universal health coverage in which the decision makers are typically concerned with coverage and equity issues. We explored the feasibility and relative advantages of the net-benefit framework (NBF) (compared to the more traditional Incremental Cost-Effectiveness Ratio, ICER) in presenting results of cost-effectiveness analysis of a community based health insurance (CBHI) scheme in Nouna, a rural district of Burkina Faso. Data were collected from April to December 2007 from Nouna’s longitudinal Demographic Surveillance System on utilization of health services, membership of the CBHI, covariates, and CBHI costs. The incremental cost of a 1 increase in utilization of health services by household members of the CBHI was 433,000 XOF ($1000 approximately). The incremental cost varies significantly by covariates. The probability of the CBHI achieving a 1% increase in utilization of health services, when the ceiling ratio is $1,000, is barely 30% for households in Nouna villages compared to 90% for households in Nouna town. Compared to the ICER, the NBF provides more useful information for policy making.
Highlights
Economic evaluation in general, and cost-effectiveness analysis in particular is deemed by scholars, health administration and policy experts a centerpiece of the decision making process by balancing health gains against costs of interventions [1]
The use of cost effectiveness analysis as a tool to inform and guide resources allocation has revolved around the Incremental Cost Effectiveness Ratio (ICER), which indicates the additional amount of money needed to obtain an extra unit of health gain or to prevent an adverse event compared to alternatives
The result is equal to 433,000 XOF and is interpreted as the overall incremental in cost for achieving one additional increase in household’s utilization of health services for households members in the community based insurance scheme compared to household non-members
Summary
Cost-effectiveness analysis in particular is deemed by scholars, health administration and policy experts a centerpiece of the decision making process by balancing health gains against costs of interventions [1]. The use of cost effectiveness analysis as a tool to inform and guide resources allocation has revolved around the Incremental Cost Effectiveness Ratio (ICER), which indicates the additional amount of money needed to obtain an extra unit of health gain or to prevent an adverse event compared to alternatives. Apart from few situations with a clearly dominant intervention (less effective and more costly or more effective and less costly) compared of handling of uncertainties and reliance on the maximum value a provider is willing to pay to achieve an extra unit in health gain for the decision rule in public health [4,5,6,7,8]. The aim of this study was to assess the feasibility and relative advantages of the net-benefit framework in assessing the cost-effectiveness of an intervention towards universal health coverage compared to the traditional ICER approach
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