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PharmacoEconomics
Published in: PharmacoEconomics 11/2009

01-11-2009 | Review Article

Cost Effectiveness in Low- and Middle-Income Countries

A Review of the Debates Surrounding Decision Rules

Authors: Mr Samuel D. Shillcutt, Damian G. Walker, Catherine A. Goodman, Anne J. Mills

Published in: PharmacoEconomics | Issue 11/2009

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Abstract

Cost-effectiveness analysis (CEA) is increasingly important in public health decision making, including in low- and middle-income countries. The decision makers’ valuation of a unit of health gain, or ceiling ratio (λ), is important in CEA as the relative value against which acceptability is defined, although values are usually chosen arbitrarily in practice. Reference case estimates for λ are useful to promote consistency, facilitate new developments in decision analysis, compare estimates against benefit-cost ratios from other economic sectors, and explicitly inform decisions about equity in global health budgets.
The aim of this article is to discuss values for λ used in practice, including derivation based on affordability expectations (such as $US150 per disabilityadjusted life-year [DALY]), some multiple of gross national income or gross domestic product, and preference-elicitation methods, and explore the implications associated with each approach. The background to the debate is introduced, the theoretical bases of current values are reviewed, and examples are given of their application in practice. Advantages and disadvantages of each method for defining λ are outlined, followed by an exploration of methodological and policy implications.
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Metadata
Title
Cost Effectiveness in Low- and Middle-Income Countries
A Review of the Debates Surrounding Decision Rules
Authors
Mr Samuel D. Shillcutt
Damian G. Walker
Catherine A. Goodman
Anne J. Mills
Publication date
01-11-2009
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 11/2009
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.2165/10899580-000000000-00000

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