Abstract
BackgroundDetermining the cost-effectiveness thresholds for healthcare interventions has been a severe challenge for policymakers, especially in low- and middle-income countries. This study aimed to estimate the cost per disability-adjusted life-year (DALY) averted for countries with different levels of Human Development Index (HDI) and Gross Domestic Product (GDP).MethodsThe data about DALYs, per capita health expenditure (HE), HDI, and GDP per capita were extracted for 176 countries during the years 2000 to 2016. Then we examined the trends on these variables. Panel regression analysis was performed to explore the correlation between DALY and HE per capita. The results of the regression models were used to calculate the cost per DALY averted for each country.ResultsAge-standardized rate (ASR) DALY (DALY per 100,000 population) had a nonlinear inverse correlation with HE per capita and a linear inverse correlation with HDI. One percent increase in HE per capita was associated with an average of 0.28, 0.24, 0.18, and 0.27% decrease on the ASR DALY in low HDI, medium HDI, high HDI, and very high HDI countries, respectively. The estimated cost per DALY averted was $998, $6522, $23,782, and $69,499 in low HDI, medium HDI, high HDI, and very high HDI countries. On average, the cost per DALY averted was 0.34 times the GDP per capita in low HDI countries. While in medium HDI, high HDI, and very high HDI countries, it was 0.67, 1.22, and 1.46 times the GDP per capita, respectively.ConclusionsThis study suggests that the cost-effectiveness thresholds might be less than a GDP per capita in low and medium HDI countries and between one and two GDP per capita in high and very high HDI countries.
Highlights
Determining the cost-effectiveness thresholds for healthcare interventions has been a severe challenge for policymakers, especially in low- and middle-income countries
The data on disability-adjusted life-year (DALY) were retrospectively extracted from the Global Burden of Disease (GBD) study, which is published by the Institute for Health Metrics and Evaluation (IHME) [11]
The DALY rate trend due to NCDs was almost constant from 2000 to 2016, whereas the trend related to injuries has not been entirely constant, with a maximum of 4496 in 2010
Summary
Determining the cost-effectiveness thresholds for healthcare interventions has been a severe challenge for policymakers, especially in low- and middle-income countries. If the ICER (cost per QALY gained or cost per DALY averted) falls below the defined threshold, the intervention is considered cost-effective. If the ICER is above the threshold, the intervention is not considered cost-effective [2, 3]. Determining the cost-effectiveness thresholds for healthcare interventions has been the topic of controversy and a significant challenge for policymakers, including prioritizing health intervention, deciding to include new interventions, and deciding how to allocate resources [4,5,6]. There are two approaches, including demand-side and supply-side approaches, for estimating the cost-effectiveness thresholds of healthcare interventions [3, 7]. The estimated monetary value for a QALY can be used as a threshold [3]
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