Research Article: When cost-effective interventions are unaffordable: Integrating cost-effectiveness and budget impact in priority setting for global health programs

Date Published: October 2, 2017

Publisher: Public Library of Science

Author(s): Alyssa Bilinski, Peter Neumann, Joshua Cohen, Teja Thorat, Katherine McDaniel, Joshua A. Salomon

Abstract: Potential cost-effective barriers in cost-effectiveness studies mean that budgetary impact analyses should also be included in post-2015 Sustainable Development Goal projects says Joshua Salomon and colleagues.

Partial Text: The post-2015 Sustainable Development Goals call for governments to combat infectious disease, reduce maternal and infant mortality, and ensure that quality healthcare is accessible and affordable to all [1]. To meet these objectives, about half of all countries are in the midst of efforts to introduce or extend universal health coverage (UHC) [2]. This process requires governments to define essential service packages guaranteed to all citizens. Because of resource limitations, these packages cannot include all health services. As a result, both researchers and policymakers have recommended prioritizing cost-effective interventions [3–5].

While political, social, and cultural factors play an important role in budget allocation, CEA can inform decisions on how to maximize health returns from limited resources. Over the past decade, interest in evaluating affordability has also increased [9,15,16]. BIA assesses affordability by estimating an intervention’s short-term net costs from the payer’s perspective [17]. Many countries, including Canada, the United Kingdom, Brazil, and Thailand request both BIA and CEA when assessing whether to include a drug on a public formulary [17–20]. In 2014, the Bill & Melinda Gates Foundation also recommended including both BIA and CEA in health economic assessments [21]. Still, BIA is rarely considered in priority-setting frameworks for UHC [16].

Designing high-quality healthcare in the era of universal coverage requires cost-effectiveness and budget impact information for health services in different settings. We found that fewer than 5% of global health CEAs conduct BIAs. With information about both cost-effectiveness and budget impact, policymakers can better develop a high-value set of programs for specific contexts. They can also identify services with high costs but high potential population health benefits for which to seek collaboration or external financial support, particularly preventative services and those that provide long-term cost savings. To promote effective incorporation of economic evidence in decision-making, researchers must address gaps in data and clearly communicate findings to policymakers.



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