Abstract
BackgroundCost effectiveness was a criterion used to revise Ethiopia’s essential health service package (EHSP) in 2019. However, there are few cost-effectiveness studies from Ethiopia or directly transferable evidence from other low-income countries to inform a comprehensive revision of the Ethiopian EHSP. Therefore, this paper reports average cost-effectiveness ratios (ACERs) of 159 health interventions used in the revision of Ethiopia’s EHSP.MethodsIn this study, we estimate ACERs for 77 interventions on reproductive maternal neonatal and child health (RMNCH), infectious diseases and water sanitation and hygiene as well as for 82 interventions on non-communicable diseases. We used the standardised World Health Organization (WHO) CHOosing Interventions that are cost effective methodology (CHOICE) for generalised cost-effectiveness analysis. The health benefits of interventions were determined using a population state-transition model, which simulates the Ethiopian population, accounting for births, deaths and disease epidemiology. Healthy life years (HLYs) gained was employed as a measure of health benefits. We estimated the economic costs of interventions from the health system perspective, including programme overhead and training costs. We used the Spectrum generalised cost-effectiveness analysis tool for data analysis. We did not explicitly apply cost-effectiveness thresholds, but we used US$100 and $1000 as references to summarise and present the ACER results.ResultsWe found ACERs ranging from less than US$1 per HLY gained (for family planning) to about US$48,000 per HLY gained (for treatment of stage 4 colorectal cancer). In general, 75% of the interventions evaluated had ACERs of less than US$1000 per HLY gained. The vast majority (95%) of RMNCH and infectious disease interventions had an ACER of less than US$1000 per HLY while almost half (44%) of non-communicable disease interventions had an ACER greater than US$1000 per HLY.ConclusionThe present study shows that several potential cost-effective interventions are available that could substantially reduce Ethiopia’s disease burden if scaled up. The use of the World Health Organization’s generalised cost-effectiveness analysis tool allowed us to rapidly calculate country-specific cost-effectiveness analysis values for 159 health interventions under consideration for Ethiopia’s EHSP.
Highlights
Cost effectiveness was a criterion used to revise Ethiopia’s essential health service package (EHSP) in 2019
The present study shows that several potential cost-effective interventions are available that could substantially reduce Ethiopia’s disease burden if scaled up
Of the total number of interventions evaluated in this study, 58 (37%) have an average cost-effectiveness ratios (ACERs) of less than US$100 per Healthy life years (HLYs), 104 (65%) have an ACER of less than US$500 per HLY and 119 (75%) have an ACER of less than US$1000 per HLY gained
Summary
Cost effectiveness was a criterion used to revise Ethiopia’s essential health service package (EHSP) in 2019. Hailu et al examine the cost effectiveness of malaria prevention interventions [8], Memirie et al examine that of maternal and neonatal interventions [9], Strand et al evaluate that of neuropsychiatric services [10], and Tolla et al examine that of cardiovascular disease prevention and treatment interventions [11] Most of those studies applied an incremental costeffectiveness approach that compares the cost effectiveness of adding new interventions against the current practice in the area [12]. With incremental/marginal analysis, it is difficult to examine whether the current mix of interventions represents an efficient use of resources [12, 13] These pieces of evidence are vital in informing the setting of priorities in decision making in specific subprogramme areas or for specific diseases, when the existing package is assumed to allocate efficiently, they are less relevant in informing the sectorwide analysis of EHSP revisions [14, 15]
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