Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK.
Bill & Melinda Gates Foundation, London, England, UK.
Value Health. 2022 Mar;25(3):385-389. doi: 10.1016/j.jval.2021.08.014. Epub 2021 Oct 29.
Evidence-informed priority setting, in particular cost-effectiveness analysis (CEA), can help target resources better to achieve universal health coverage. Central to the application of CEA is the use of a cost-effectiveness threshold. We add to the literature by looking at what thresholds have been used in published CEA and the proportion of interventions found to be cost-effective, by type of threshold.
We identified CEA studies in low- and middle-income countries from the Global Health Cost-Effectiveness Analysis Registry that were published between January 1, 2015, and January 6, 2020. We extracted data on the country of focus, type of interventions under consideration, funder, threshold used, and recommendations.
A total of 230 studies with a total 713 interventions were included in this review; 1 to 3× gross domestic product (GDP) per capita was the most common type of threshold used in judging cost-effectiveness (84.3%). Approximately a third of studies (34.2%) using 1 to 3× GDP per capita applied a threshold at 3× GDP per capita. We have found that no study used locally developed thresholds. We found that 79.3% of interventions received a recommendation as "cost-effective" and that 85.9% of studies had at least 1 intervention that was considered cost-effective. The use of 1 to 3× GDP per capita led to a higher proportion of study interventions being judged as cost-effective compared with other types of thresholds.
Despite the wide concerns about the use of 1 to 3× GDP per capita, this threshold is still widely used in the literature. Using this threshold leads to more interventions being recommended as "cost-effective." This study further explore alternatives to the 1 to 3× GDP as a decision rule.
循证的重点制定，特别是成本效益分析（CEA），可以帮助更好地将资源用于实现全民健康覆盖。CEA 的应用核心是使用成本效益阈值。我们通过查看已发表的 CEA 中使用的阈值以及按阈值类型发现的具有成本效益的干预措施的比例，为文献做出了贡献。
我们从全球卫生成本效益分析登记处确定了 2015 年 1 月 1 日至 2020 年 1 月 6 日期间在低收入和中等收入国家发表的 CEA 研究。我们提取了有关重点国家、考虑中的干预措施类型、资助者、使用的阈值和建议的数据。
共有 230 项研究共 713 项干预措施纳入本综述；判断成本效益的最常见阈值类型是 1 至 3 倍国内生产总值（GDP）人均（84.3%）。大约三分之一（34.2%）使用 1 至 3 倍 GDP 人均的研究在 3 倍 GDP 人均时应用了阈值。我们发现没有研究使用本地开发的阈值。我们发现 79.3%的干预措施被建议为“具有成本效益”，85.9%的研究至少有一项被认为具有成本效益。与其他类型的阈值相比，使用 1 至 3 倍 GDP 人均导致更多的研究干预措施被判断为具有成本效益。
尽管人们广泛关注使用 1 至 3 倍 GDP 人均，但该阈值在文献中仍被广泛使用。使用该阈值会导致更多的干预措施被建议为“具有成本效益”。本研究进一步探讨了替代 1 至 3 倍 GDP 作为决策规则的方法。
