University of California, San Francisco, CA, USA.
Amur Consultancy, Dublin, Irelan.
Int J Health Policy Manag. 2017 Apr 1;6(4):191-194. doi: 10.15171/ijhpm.2016.155.
Cost-effectiveness analysis (CEA), as a system of allocative efficiency for global health programs, is an influential criterion for resource allocation in the context of diplomacy and inherent foreign policy decisions therein. This is because such programs have diplomatic benefits and costs that can be uploaded from the recipient and affect the broader foreign policy interests of the donor and the diplomacy landscape between both parties. These diplomatic implications are vital to the long-term success of both the immediate program and any subsequent programs; hence it is important to articulate them alongside program performance, in terms of how well their interrelated interventions were perceived by the communities served. Consequently, the exclusive focus of cost-effectiveness on medical outcomes ignores (1) the potential non-health benefits of less cost-effective interventions and (2) the potential of these collateral gains to form compelling cases across the interdisciplinary spectrum to increase the overall resource envelope for global health. The assessment utilizes the Kevany Riposte's "K-Scores" methodology, which has been previously applied as a replicable evaluation tool1 and assesses the trade-offs of highly cost-effective but potentially "undiplomatic" global health interventions. Ultimately, we apply this approach to selected HIV/AIDS interventions to determine their wider benefits and demonstrate the value alternative evaluation and decision-making methodologies. Interventions with high "K-Scores" should be seriously considered for resource allocation independent of their cost-effectiveness. "Oregon Plan" thresholds2 are neither appropriate nor enforceable in this regard while "K-Score" results provide contextual information to policy-makers who may have, to date, considered only cost-effectiveness data. While CEA is a valuable tool for resource allocation, its use as a utilitarian focus should be approached with caution. Policy-makers and global health program managers should take into account a wide range of outcomes before agreeing upon selection and implementation.
成本效益分析（CEA）作为全球卫生计划的配置效率系统，是外交和固有外交政策决策中资源分配的一个有影响力的标准。这是因为这些项目具有外交收益和成本，可以从接受方上传，并影响捐助方的更广泛的外交利益和双方之间的外交格局。这些外交影响对于当前项目和任何后续项目的长期成功至关重要；因此，重要的是要在项目表现的基础上阐明这些影响，以及社区对其相关干预措施的看法。因此，成本效益分析对医疗结果的唯一关注忽略了（1）成本效益较低的干预措施的潜在非健康收益，以及（2）这些附带收益在跨学科范围内形成有说服力案例的潜力，以增加全球卫生的总体资源包。该评估利用了 Kevany Riposte 的“K 分数”方法，该方法以前曾被用作可复制的评估工具 1，并评估了高度成本效益但可能具有“非外交性”的全球卫生干预措施的权衡。最终，我们将这种方法应用于选定的艾滋病毒/艾滋病干预措施，以确定其更广泛的益处，并展示替代评估和决策方法的价值。具有高“K 分数”的干预措施应独立于其成本效益而受到认真考虑用于资源分配。“俄勒冈计划”门槛 2 在这方面既不适当也不可执行，而“K 分数”结果为决策者提供了背景信息，他们迄今为止可能只考虑了成本效益数据。虽然 CEA 是资源分配的宝贵工具，但在使用时应谨慎对待其作为功利主义焦点的应用。政策制定者和全球卫生项目管理者在同意选择和实施之前，应考虑广泛的结果。
