Challenging the Status Quo: Report Urges the Use of Local Context to Determine Cost-Effectiveness Thresholds in Low- and Middle-income Countries

Lawrenceville, NJ, USA—July 23, 2018—Value in Health, the official journal of ISPOR (the professional society for health economics and outcomes research), announced today the publication of a study challenging the use of generic global benchmarks in the establishment of cost-effectiveness analysis thresholds in low- and middle-income countries. The report, Use and Misuse of Cost-Effectiveness Analysis Thresholds in Low- and Middle-Income Countries: Trends in Cost-per-DALY Studies, was published in the July 2018 issue of Value in Health.

This study addresses an issue more than a decade in the making. In 2002, the World Health Organization (WHO) defined as “cost effective” those interventions with a cost-per-disability-adjusted life-year of 1 to 3 times a country’s annual per capita gross domestic product (GDP). It is important to note, however, that the WHO has since explicitly backed away from this convention, as the origins of its use were never intended to set the threshold criterion for cost-effectiveness analysis. Nevertheless, this threshold range roughly corresponds to what has become convention for high-income countries such as the United States, but extrapolation to low- and middle-income countries may not be valid given their pronounced resource constraints and contextual considerations that must be considered when placing value on health.

According to these researchers from Tufts Medical Center, instead of relying on the 1 to 3 times per capita GDP as a convention, the global health economics field should develop threshold assumptions that are valid for each applicable setting. Indeed, rather than relying on any commonly used, generic economic thresholds, the authors encourage the use of context-specific thresholds that reflect local preferences.

“Ideally and theoretically, each country should develop its own cost-effectiveness thresholds to inform resource allocation and preferences reflecting the healthcare system at large,” said lead author Ashley A. Leech, PhD, MS, Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. “Although we acknowledge the practical limitations of this task, our findings represent a call to action for key international agencies to reexamine standard criteria for designating an intervention as having reasonable value for investment.”



ISPOR, the professional society for health economics and outcomes research (HEOR), is an international, multistakeholder, nonprofit dedicated to advancing HEOR excellence to improve decision making for health globally. The Society is the leading source for scientific conferences, peer-reviewed and MEDLINE®-indexed publications, good practices guidance, education, collaboration, and tools/resources in the field.
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Value in Health (ISSN 1098-3015) is an international, indexed journal that publishes original research and health policy articles that advance the field of health economics and outcomes research to help healthcare leaders make evidence-based decisions. The journal’s 2017 impact factor score is 5.494. Value in Health is ranked 3rd among 94 journals in healthcare sciences and services, 3rd among 79 journals in health policy and services, and 6th among 353 journals in economics. Value in Health is a monthly publication that circulates to more than 10,000 readers around the world.

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