Economic Evaluation of Healthcare Programmes and Interventions in Low and Middle Income Countries: Directions for Future Methods Research

Abstract

In countries across the globe, difficult decisions have to be made (whether implicitly or explicitly) as to how healthcare is financed, organized and provided to meet the needs of populations. The range of interventions that could generate health gains for patients invariably exceeds what can be provided from available budgets. These decisions have to be made in all countries –from Switzerland to Swaziland – but the levels of available resources and healthcare needs differ widely across settings. It is estimated that, somewhat incongruously, only fifteen percent of global healthcare expenditure is in low-and middle-income countries, where eighty five percent of people live and which suffer from ninety-two percent of the world’s disease burden. We explore the tools and approaches available to inform healthcare resource allocation decisions in different kinds of healthcare systems. The paper focuses on identifying opportunities to improve the methods of economic evaluation in LMICs. Other barriers to the useful application of economic evaluation such as local research capacity and decision-context barriers (e.g. understanding of methods by policy makers, as well as social, political, institutional and ethical factors) are acknowledged but are beyond the scope ofthis paper.