Abstract
ObjectiveWe aimed to estimate the maximum intervention cost (EMIC) a society could invest in a life-saving intervention at different ages while remaining cost-effective according to a user-specified cost-effectiveness threshold.MethodsNew Zealand (NZ) was used as a case study, and a health system perspective was taken. Data from NZ life tables and morbidity data from a burden of disease study were used to estimate health-adjusted life-years (HALYs) gained by a life-saving intervention. Health system costs were estimated from a national database of all publicly funded health events (hospitalizations, outpatient events, pharmaceuticals, etc.). For illustrative purposes we followed the WHO-CHOICE approach and used a cost-effectiveness threshold of the gross domestic product (GDP) per capita (NZ$45,000 or US$30,000 per HALY). We then calculated EMICs for an “ideal” life-saving intervention that fully returned survivors to the same average morbidity, mortality, and cost trajectories as the rest of their cohort.FindingsThe EMIC of the “ideal” life-saving intervention varied markedly by age: NZ$1.3 million (US$880,000) for an intervention to save the life of a child, NZ$0.8 million (US$540,000) for a 50-year-old, and NZ$0.235 million (US$158,000) for an 80-year-old. These results were predictably very sensitive to the choice of discount rate and to the selected cost-effectiveness threshold. Using WHO data, we produced an online calculator to allow the performance of similar calculations for all other countries.ConclusionsWe present an approach to estimating maximal cost-effective investment in life-saving health interventions, under various assumptions. Our online calculator allows this approach to be applied in other countries. Policymakers could use these estimates as a rapid screening tool to determine if more detailed cost-effectiveness analyses of potential life-saving interventions might be worthwhile or which proposed life-saving interventions are very unlikely to benefit from such additional research.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-015-0052-2) contains supplementary material, which is available to authorized users.
Highlights
Many countries spend a substantial proportion of their gross domestic product (GDP) on health, e.g., at least 10 % in high-income countries such as New Zealand [1, 2]
We present an approach to estimating maximal cost-effective investment in life-saving health interventions, under various assumptions
Our online calculator allows this approach to be applied in other countries. Policymakers could use these estimates as a rapid screening tool to determine if more detailed cost-effectiveness analyses of potential life-saving interventions might be worthwhile or which proposed life-saving interventions are very unlikely to benefit from such additional research
Summary
Many countries spend a substantial proportion of their gross domestic product (GDP) on health, e.g., at least 10 % in high-income countries such as New Zealand [1, 2]. The rapid rise in health spending at a rate faster than GDP growth (due to income growth, technological change, population growth, and aging), is unlikely to be tenable in the long term [3,4,5]. In the ideal world policymakers would probably have the results of studies that identified the country-specific willingness-to-pay value that society places on saving a life at different ages. In such an ideal world, they may have a methodologically compatible league table of life-saving and health-gaining interventions – to inform the “ best” intervention to adopt from a costeffectiveness perspective within a government’s available health budget. Most countries are a long way from having such information available, and they often have limited resources for conducting new cost-effectiveness analyses (which can take many months and cost tens of thousands of dollars per intervention modeled)
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