Institute for Clinical Effectiveness and Health Policy (IECS), National Scientific and Technical Research Council, Buenos Aires, Argentina; School of Public Health, University of Buenos Aires, Buenos Aires, Argentina.
Centre for Health Economics, University of York, York, UK.
Lancet Glob Health. 2023 Jun;11(6):e833-e842. doi: 10.1016/S2214-109X(23)00162-6.
Assessment of the efficiency of interventions is paramount to achieving equitable health-care systems. One key barrier to the widespread use of economic evaluations in resource allocation decisions is the absence of a widely accepted method to define cost-effectiveness thresholds to judge whether an intervention is cost-effective in a particular jurisdiction. We aimed to develop a method to estimate cost-effectiveness thresholds on the basis of health expenditures per capita and life expectancy at birth and empirically derive these thresholds for 174 countries.
We developed a conceptual framework to assess how the adoption and coverage of new interventions with a given incremental cost-effectiveness ratio will affect the rate of increase of health expenditures per capita and life expectancy at the population level. The cost-effectiveness threshold can be derived so that the effect of new interventions on the evolution of life expectancy and health expenditure per capita is set within predefined goals. To provide guidance on cost-effectiveness thresholds and secular trends for 174 countries, we projected country-level health expenditure per capita and life expectancy increases by income level based on World Bank data for the period 2010-19.
Cost-effectiveness thresholds per quality-adjusted life-year (QALY) ranged between US$87 (Democratic Republic of the Congo) and $95 958 (USA) and were less than 0·5 gross domestic product (GDP) per capita in 96% of low-income countries, 76% of lower-middle-income countries, 31% of upper-middle-income countries, and 26% of high-income countries. Cost-effectiveness thresholds per QALY were less than 1 GDP per capita in 168 (97%) of the 174 countries. Cost-effectiveness thresholds per life-year ranged between $78 and $80 529 and between 0·12 and 1·24 GDP per capita, and were less than 1 GDP per capita in 171 (98%) countries.
This approach, based on widely available data, can provide a useful reference for countries using economic evaluations to inform resource-allocation decisions and can enrich international efforts to estimate cost-effectiveness thresholds. Our results show lower thresholds than those currently in use in many countries.
Institute for Clinical Effectiveness and Health Policy (IECS).
评估干预措施的效率对于实现公平的医疗保健系统至关重要。在资源分配决策中广泛使用经济评估的一个关键障碍是缺乏广泛接受的方法来定义成本效益阈值，以判断干预措施在特定司法管辖区是否具有成本效益。我们旨在开发一种方法，根据人均卫生支出和出生时预期寿命来估算成本效益阈值，并根据 174 个国家的实际数据得出这些阈值。
我们开发了一个概念框架，以评估具有给定增量成本效益比的新干预措施的采用和覆盖范围将如何影响人均卫生支出和人口预期寿命的增长率。可以根据新干预措施对预期寿命和人均卫生支出演变的影响来确定成本效益阈值，使其符合预先设定的目标。为了为 174 个国家提供成本效益阈值和长期趋势的指导，我们根据世界银行 2010-19 年的数据，按收入水平预测了各国的人均卫生支出和预期寿命增长。
每质量调整生命年（QALY）的成本效益阈值范围为 87 美元（刚果民主共和国）至 95958 美元（美国），在 96%的低收入国家、76%的中下收入国家、31%的中上收入国家和 26%的高收入国家中，低于人均 0.5 个国内生产总值（GDP）。在 174 个国家中，168 个（97%）国家的每 QALY 成本效益阈值低于人均 1 GDP。每生命年的成本效益阈值范围为 78 美元至 80529 美元，占人均 0.12 至 1.24 GDP，在 171 个（98%）国家中低于人均 1 GDP。
这种方法基于广泛可用的数据，可以为使用经济评估来为资源分配决策提供信息的国家提供有用的参考，并丰富国际上估算成本效益阈值的努力。我们的结果表明，这些阈值低于许多国家目前使用的阈值。
临床效果和健康政策研究所（IECS）。
