World Health Organization Publication : Year 2003 ; Issue 9241546018: World Health Organization Guide to Cost-Effectiveness Analysis

By T. Tan Torres Edejer

Book Id: WPLBN0000172695
Format Type: PDF eBook
File Size: 4.8 MB
Reproduction Date: 2005

Title:	World Health Organization Publication : Year 2003 ; Issue 9241546018: World Health Organization Guide to Cost-Effectiveness Analysis
Author:	T. Tan Torres Edejer
Volume:
Language:	English
Subject:	Health., Public health, Wellness programs
Collections:	Medical Library Collection, World Health Collection
Historic Publication Date:
Publisher:	World Health Organization


Citation APA MLA Chicago Torres Edejer, T. T. (n.d.). World Health Organization Publication : Year 2003 ; Issue 9241546018. Retrieved from http://gutenberg.cc/

Description
Medical Reference Publication

Excerpt
A number of guidelines on cost-effectiveness analysis (CEA) already exist. There are two reasons for producing another set. The first is that traditional analysis has focused on assessing new or additional interventions in comparison with current practice in that area. It is difficult to use this type of “incremental” analysis to determine if the current mix of interventions represents an efficient use of resources. Secondly, for all but the richest countries, the cost and time required to evaluate the large number of interventions and identify opportunities to enhance efficiency are prohibitive. It is important to maximize the possibility of generalizing results from one setting to another. The approach of generalized CEA (GCEA) proposed in this Guide seeks to provide analysts with a method of assessing whether the current mix of interventions is efficient as well as whether a proposed new technology or intervention is appropriate. It also seeks to maximize the generalizability of results across settings. The WHO Guide to Cost-Effectiveness Analysis should be considered as complementary to existing guidelines on CEA. GCEA proposes the evaluation of interventions against the counterfactual of “doing nothing”, thereby providing decision-makers with information on what could be achieved if they could start again to build the health system, i.e. reallocate all health resources. As will be shown in the Guide, this information is a prerequisite to the definition of an efficient mix of interventions, achievable in the long run. This specific feature—not addressed in traditional CEA which typically evaluates new interventions in comparison with the current mix (intervention mix constrained CEA or IMC-CEA)—categorizes GCEA as a different, more fundamental, type of economic analysis. For many narrower applications of CEA, such as the appraisal of a new version of an existing drug in a specific country, the currently practised CEA remains an appropriate method although it should be realized that this does not inform decision-makers on the best use of health resources in general.i It is also possible to undertake a traditional analysis as part of a GCEA.

Table of Contents
CONTENTS Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IX List of Acronyms and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . XXI PART ONE: METHODS FOR GENERALIZED COST-EFFECTIVENESS ANALYSIS 1. What is Generalized Cost-Effectiveness Analysis? . . . . . . . . . . . . 3 2. Undertaking a study using GCEA . . . . . . . . . . . . . . . . . . . . . . . 17 3. Estimating costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 4. Estimating health effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 5. Discounting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 6. Uncertainty in cost-effectiveness analysis . . . . . . . . . . . . . . . . . . 73 7. Policy uses of Generalized CEA . . . . . . . . . . . . . . . . . . . . . . . . 83 8. Reporting CEA results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 9. Summary of recommendations . . . . . . . . . . . . . . . . . . . . . . . . . 93 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Annex A. WHO-CHOICE activities on Generalized Cost-Effectiveness Analysis . . . . . . . . . . . . . . . . . . . . . . . 107 Annex B. Draft list of intervention clusters for evaluation by WHO-CHOICE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Annex C. An illustration of the types of costs included in a selection of intervention activities at central levels . . . . . 111 Annex D. Interpreting international dollars. . . . . . . . . . . . . . . . . . . 112 Annex E. DALYs to measure burden of disease. . . . . . . . . . . . . . . . 113 Annex F. Measuring intervention benefit at the population level . . . 115 Annex G. Epidemiological subregions as applied in WHO Generalized CEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Endnotes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119