Abstract
Background: World Health Organization Choosing Interventions that are Cost-Effective (WHO CHOICE) has been a programme of the WHO for 20 years. In this latest update, we present for the first time a cross-programme analysis of the comparative cost-effectiveness of 479 intervention scenarios across 20 disease programmes and risk factors. Methods: This analysis follows the standard WHO CHOICE approach to generalized cost-effectiveness analysis applied to two regions, Eastern sub-Saharan Africa and Southeast Asia. The scope of the analysis is all interventions included in programme specific WHO CHOICE analyses, using WHO treatment guidelines for major disease areas as the foundation. Costs are measured in 2010 international dollars, and benefits modelled beginning in 2010, or the nearest year for which validated data was available, both for a period of 100 years. Results: Across both regions included in the analysis, interventions span multiple orders of magnitude in terms of cost-effectiveness ratios. A health benefit package optimized through a value for money lens incorporates interventions responding to all of the main drivers of disease burden. Interventions delivered through first level clinical and non-clinical services represent the majority of the high impact cost-effective interventions. Conclusion: Cost-effectiveness is one important criterion when selecting health interventions for benefit packages to progress towards universal health coverage (UHC), but it is not the only criterion and all calculations should be adapted to the local context. To support country decision-makers, WHO CHOICE has developed a downloadable tool to support the development of data for this criterion.
Highlights
World HeCalltehmOetrgAasnkizhaetiimon, KCrhiostoisninHgeIgngteernv,eEnitvioinnds tEhnagt eabrereCtsoesnt-**Effective (WHO CHOICE) has been a programme of the World Health Organization (WHO) for 20 years
This paper shows how cost-effectiveness can be used to support the development of an optimized health benefit package to support progress to universal health coverage (UHC)
The full WHO CHOICE generalized cost-effectiveness methodology has been published separately,[10,21,26] all updates and relevant methods for this series are described in full in a separate paper within this series[26] and disease specific adaptations outlined in the appropriate papers[27,28,30] These interventions reflect either single interventions, interventions analyzed at varying coverage levels, or small bundles of interventions for which there is a clinical reason to deliver as a package
Summary
This to two regions, analysis Eastern fsoAIgunllboblosab-twaSrrlaaeshcchteteahnareltathsan.tratWAincelfder,cailcrGaadiomarWinkthdHOatOSoOomCuosmtHhhsaeOsiasIsdCitrnaEAdwisarniepacap.ttlrtTyeonhsautecibohmsnctioottotpigneteghnoeteofnrtaoahrlleimizbeaaetdrniavalcelcoyuossnntis-dceeeifprsfpteiaiocnlntlniivionnefgtnpeseoroslvifsteitnachsnteibaopylnyofsslriiatsiimncascipnloupgfdlieedd in programme specific WtheHpOolitCicHs oOfIgCloEbaalnhaelayltshesa,s uasiqnugestWionHoOf intrdeivaitdmuaelnmt ogruailidtye.liDnreaswifnogr omn atjhoerthdeiosreeatsicealawreoarsksaosf the foundation. Interventions delivered through first level clinical and nonclinical services represenCtotphyerimghatj:o©ri2t0y16ofbythKeerhmiganhUimnivpearcsittycoofsMt-edffiecacltiSvceienincetesrventions. For this WHO CHOICE sectoral analysis, we take the costeffectiveness ratios for 479 interventions across 20 disease/ risk factor groups that have been calculated using the common generalized cost-effectiveness methodology of WHO CHOICE. The full WHO CHOICE generalized cost-effectiveness methodology has been published separately,[10,21,26] all updates and relevant methods for this series are described in full in a separate paper within this series[26] and disease specific adaptations outlined in the appropriate papers[27,28,30] These interventions reflect either single interventions, interventions analyzed at varying coverage levels, or small bundles of interventions for which there is a clinical reason to deliver as a package. We present the results with 3% discounting of costs and 0% discounting of health benefits
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