The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy

Objectives: Cost-effectiveness (CE) is increasingly used for resource allocationworldwide. One key hurdle for its widespread use is the lack of a widely acceptedmethodology to derive thresholds at the healthcare system (HS) or country level.The objective is to propose a methodology and derive local...

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Autores: Pichón-Riviere, Andrés, Augustovski, Federico Ariel, Garcia Marti, S, Caporale, J
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2015
País:Argentina
Institución:Consejo Nacional de Investigaciones Científicas y Técnicas
Repositorio:CONICET Digital (CONICET)
Idioma:inglés
OAI Identifier:oai:ri.conicet.gov.ar:11336/42262
Acceso en línea:http://hdl.handle.net/11336/42262
Access Level:acceso abierto
Palabra clave:Cost-Efectiveness
https://purl.org/becyt/ford/3.2
https://purl.org/becyt/ford/3
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spelling The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life ExpectancyPichón-Riviere, AndrésAugustovski, Federico ArielGarcia Marti, SCaporale, JCost-Efectivenesshttps://purl.org/becyt/ford/3.2https://purl.org/becyt/ford/3Objectives: Cost-effectiveness (CE) is increasingly used for resource allocationworldwide. One key hurdle for its widespread use is the lack of a widely acceptedmethodology to derive thresholds at the healthcare system (HS) or country level.The objective is to propose a methodology and derive local CE thresholds basedon per capita health expenditures (pcHE) and life expectancy (LE). Methods:Our approach is based on the relationship between pcHE and LE; assuming thatthe increase in expenditures reflects the CE of the interventions added to reachcurrent LE. For HS willing to maintain or increase their secular trend of raisingpcHE in order to improve health, the threshold (measured in units of pcHE) willbe: Threshold=(LE+1)*i-LE; where LE is measured in life-years (LY) or QALYs; and?i? is the ratio of increase in pcHE that the HS is willing to accept to increase LEby one unit (eg i=1.09 for a 9% increase). For HS with cost-containment mandates:Threshold=LE-((LE-1)/i), where ?i? represents the past increase in pcHE togain the last unit of LE. We used OLS to predict ?i? for 185 countries, followingboth a cross-sectional (2013) and a longitudinal approach (2003-2013) using WorldBank data. Results: Depending on income strata and LE, countries can expect toincrease pcHE by 7-10% for an additional LY and between 10-13% for an additionalQALY. This represent cost per QALY thresholds ranging from 9-11 pcHE in HighIncometo 5-8 in Low-Income countries, which translates to thresholds of 32-40thousands US dollars in UK; 83-101 in USA; 6-7 in Mexico and 0.5 in Uganda (around0.9, 1.8, 0.6 and 0.7 GDP per capita respectively). Conclusions: This approach,based on widely available data, can be useful to inform decisions in all countriesusing economic evaluations. Our results show thresholds usually lower than thosepromoted by WHOFil: Pichón-Riviere, Andrés. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Augustovski, Federico Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Garcia Marti, S. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Caporale, J. Instituto de Efectividad Clínica y Sanitaria; ArgentinaWiley Blackwell Publishing, Inc2015-11info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/42262Pichón-Riviere, Andrés; Augustovski, Federico Ariel; Garcia Marti, S; Caporale, J; The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy; Wiley Blackwell Publishing, Inc; Value In Health; 18; 7; 11-2015; A695-A6961098-3015CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/doi/10.1016/j.jval.2015.09.2592info:eu-repo/semantics/altIdentifier/url/https://www.sciencedirect.com/science/article/pii/S1098301515046689info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2024-05-08T13:46:14Zoai:ri.conicet.gov.ar:11336/42262instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982024-05-08 13:46:14.638CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy
title The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy
spellingShingle The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy
Pichón-Riviere, Andrés
Cost-Efectiveness
https://purl.org/becyt/ford/3.2
https://purl.org/becyt/ford/3
title_short The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy
title_full The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy
title_fullStr The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy
title_full_unstemmed The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy
title_sort The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy
dc.creator.none.fl_str_mv Pichón-Riviere, Andrés
Augustovski, Federico Ariel
Garcia Marti, S
Caporale, J
author Pichón-Riviere, Andrés
author_facet Pichón-Riviere, Andrés
Augustovski, Federico Ariel
Garcia Marti, S
Caporale, J
author_role author
author2 Augustovski, Federico Ariel
Garcia Marti, S
Caporale, J
author2_role author
author
author
dc.subject.none.fl_str_mv Cost-Efectiveness
https://purl.org/becyt/ford/3.2
https://purl.org/becyt/ford/3
topic Cost-Efectiveness
https://purl.org/becyt/ford/3.2
https://purl.org/becyt/ford/3
description Objectives: Cost-effectiveness (CE) is increasingly used for resource allocationworldwide. One key hurdle for its widespread use is the lack of a widely acceptedmethodology to derive thresholds at the healthcare system (HS) or country level.The objective is to propose a methodology and derive local CE thresholds basedon per capita health expenditures (pcHE) and life expectancy (LE). Methods:Our approach is based on the relationship between pcHE and LE; assuming thatthe increase in expenditures reflects the CE of the interventions added to reachcurrent LE. For HS willing to maintain or increase their secular trend of raisingpcHE in order to improve health, the threshold (measured in units of pcHE) willbe: Threshold=(LE+1)*i-LE; where LE is measured in life-years (LY) or QALYs; and?i? is the ratio of increase in pcHE that the HS is willing to accept to increase LEby one unit (eg i=1.09 for a 9% increase). For HS with cost-containment mandates:Threshold=LE-((LE-1)/i), where ?i? represents the past increase in pcHE togain the last unit of LE. We used OLS to predict ?i? for 185 countries, followingboth a cross-sectional (2013) and a longitudinal approach (2003-2013) using WorldBank data. Results: Depending on income strata and LE, countries can expect toincrease pcHE by 7-10% for an additional LY and between 10-13% for an additionalQALY. This represent cost per QALY thresholds ranging from 9-11 pcHE in HighIncometo 5-8 in Low-Income countries, which translates to thresholds of 32-40thousands US dollars in UK; 83-101 in USA; 6-7 in Mexico and 0.5 in Uganda (around0.9, 1.8, 0.6 and 0.7 GDP per capita respectively). Conclusions: This approach,based on widely available data, can be useful to inform decisions in all countriesusing economic evaluations. Our results show thresholds usually lower than thosepromoted by WHO
publishDate 2015
dc.date.none.fl_str_mv 2015-11
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/42262
Pichón-Riviere, Andrés; Augustovski, Federico Ariel; Garcia Marti, S; Caporale, J; The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy; Wiley Blackwell Publishing, Inc; Value In Health; 18; 7; 11-2015; A695-A696
1098-3015
CONICET Digital
CONICET
url http://hdl.handle.net/11336/42262
identifier_str_mv Pichón-Riviere, Andrés; Augustovski, Federico Ariel; Garcia Marti, S; Caporale, J; The Efficiency Path: An Estimation of Cost-Effectiveness Thresholds for 185 Countries Based on Per Capita Health Expenditures and Life Expectancy; Wiley Blackwell Publishing, Inc; Value In Health; 18; 7; 11-2015; A695-A696
1098-3015
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/doi/10.1016/j.jval.2015.09.2592
info:eu-repo/semantics/altIdentifier/url/https://www.sciencedirect.com/science/article/pii/S1098301515046689
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Wiley Blackwell Publishing, Inc
publisher.none.fl_str_mv Wiley Blackwell Publishing, Inc
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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