Development of WHO guidelines on generalized cost-effectiveness analysis

Murray, Christopher J L; Evans, David B.; Acharya, Amitabha; Baltussen, Rob

doi:10.1002/(sici)1099-1050(200004)9:3<235::aid-hec502>3.0.co;2-o

Cited by 483 publications

(369 citation statements)

References 123 publications

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“…The standard WHO ingredients approach, with separate specification of units of utilisation and costs, is adopted 34 . Costs are expressed in international dollars (I$) to facilitate more meaningful comparisons across regions.…”

Section: Estimated Costs and Cost-effectiveness Of Different Intervenmentioning

confidence: 99%

Iron and zinc deficiencies in China: what is a feasible and cost-effective strategy?

Jin

et al. 2008

Public Health Nutr.

136

123

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In order to prioritise interventions for micronutrient deficiencies in China, the populations affected by iron and zinc deficiencies were assessed based on data from the 2002 China National Nutrition and Health Survey. The costs and costeffectiveness of supplementation, food diversification and food fortification were estimated using the standard World Health Organization ingredients approach. Results indicated that 30% of children (,2 years), adults (.60 years), pregnant and lactating women, and 20% of women of reproductive age were anaemic, some 245 million people. Approximately 100 million people were affected by zinc deficiency (zinc intake inadequacy and stunting), the majority living in rural areas. Among interventions on iron and zinc deficiency, biofortification showed the lowest costs per capita, I$0.01 (international dollars), while dietary diversification through health education represented the highest costs at I$1148. The costeffectiveness of supplementation, food fortification and dietary diversification for iron deficiency alone was I$179, I$66 and I$103 per disability-adjusted life-year (DALY), respectively. Data for biofortification were not available. For zinc deficiency, the corresponding figures were I$399, I$153 and I$103 per DALY, respectively. In conclusion, iron and zinc deficiencies are of great public health concern in China. Of the two long-term intervention strategies, i.e. dietary diversification and biofortification with improved varieties, the latter is especially feasible and cost-effective for rural populations. Supplementation and fortification can be used as short-term strategies for specific groups. Keywords Micronutrient deficiencyIron Zinc Cost-effectiveness ChinaThe latest World Health Organization (WHO) estimates reveal that undernutrition is an underlying cause of 53% of all deaths in children ,5 years of age 1 . It has been estimated that more than 2 billion of the world's population, nearly all in developing countries, are irondeficient 2,3 . Billions of individuals are also at risk for zinc deficiency 4 . Micronutrient deficiency not only affects the health and development of people 5-9 , but also hinders the social and economic development of countries. It is estimated that the loss in economic productivity due to iron deficiency in China is more than 3.6% of the gross national product 10 .The causes of micronutrient deficiencies include inadequate intakes, impaired absorption and/or utilisation, excessive losses, increased physiological need or the combination of these factors 11 . Insufficient intake and poor bioavailability are major causes in developing countries [12][13][14] . Micronutrient content and bioavailability can be improved by either increasing the quantity of a micronutrient or increasing enhancing factors/decreasing inhibiting factors in foods using different techniques or sources. Strategies for increasing the effective supply of nutrients fall into two categories, supplementation and food-based approaches. Supplementation is the addition of ...

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Section: Estimated Costs and Cost-effectiveness Of Different Intervenmentioning

confidence: 99%

Iron and zinc deficiencies in China: what is a feasible and cost-effective strategy?

Jin

et al. 2008

Public Health Nutr.

136

123

View full text Add to dashboard Cite

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“…The 1993 World Development Report [10] concentrated on ''investing in health'' and introduced Disability Adjusted Life Years (DALY) as the criterion for allocation of funds [11]. Based on the strong economic capacity of the World Bank, health economic analysis became a new standard for development aid.…”

Section: History Of Health-related Development Aidmentioning

confidence: 99%

Health-related development aid: what comes after it?

Fleßa

2013

Eur J Health Econ

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“…Given that normally a health-care system delivers numerous interventions, it is important to note that many interactions between interventions in terms of costs and effects will be present but cannot be accounted for in isolated CEAs. For example, passive case detection and DOTS treatment interacts with BCG vaccination in terms of costs and outcomes (10).…”

Section: The Practice Of Cost-effectiveness Analysismentioning

confidence: 99%

“…The required cost-effectiveness information should be seen as only one input into the policy debate on priorities, which includes several other criteria reflecting goals of health systems (10). Given the multiple goals in health care, rather than a formulaic approach, economic analysis is probably most powerful when it is ultimately used to classify interventions into broad groups of cost-effectiveness: those that are very cost-effective, cost-effective, and not cost-effective.…”

Section: Do Not Let the Perfect Be The Enemy Of The Goodmentioning

confidence: 99%

Cost-effectiveness analysis for priority setting in health: Penny-wise but pound-foolish

Baltussen

Brouwer

Niessen

2005

Int J Technol Assess Health Care

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Cost-effectiveness analysis has much conceptual attractiveness in priority setting but is not used to its full potential to assist policy-makers on making choices in health in developed or in developing countries. We call for a shift away from present economic evaluation activities-that tend to produce ad hoc and incomparable economic evaluation studies and, therefore, add little to the compendium of knowledge of cost-effectiveness of health interventions in general-toward a more systematic approach. Research efforts in economic evaluation should build on the foundations of cost-effectiveness research of the past decades to arrive at an informative methodology useful for national policy-makers. This strategy means that governments should steer sectoral cost-effectiveness analysis to obtain systematic and comprehensive information on the economic attractiveness of a set of new and current interventions, using a standardized methodology and capturing interactions between interventions. Without redirecting the focus of economic evaluation research, choosing in health care bears the risk to remain penny-wise but pound-foolish. Keywords: Cost-effectiveness, Economic evaluation, Priority setting, MethodologyCost-effectiveness analysis (CEA) has often been proposed to guide priority setting in health but is not used to its full potential in developed or in developing countries. In the absence of central guidance, present research is dominated by studies of new interventions compared with current practice, without referral to the question of which interventions are most important to evaluate or the appropriateness of current practice. This absence provides policy-makers with incomprehensive or even misleading information to guide allocation decisions in health.If economic evaluation is to facilitate the process of priority setting effectively, a clear vision of what needs to be achieved and how this can be done is required. Here, we propose a reformulation of economic evaluation appropriate for the challenges in priority setting.

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Development of WHO guidelines on generalized cost-effectiveness analysis

Cited by 483 publications

References 123 publications

Iron and zinc deficiencies in China: what is a feasible and cost-effective strategy?

Iron and zinc deficiencies in China: what is a feasible and cost-effective strategy?

Health-related development aid: what comes after it?

Cost-effectiveness analysis for priority setting in health: Penny-wise but pound-foolish

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