ESPE Yearbook of Paediatric Endocrinology

Brief summary: This article develops a framework to assess the effect of adoption of new health interventions on rates of healthcare expenditure using a cost-effectiveness threshold. This detailed economic analysis is applied to 174 countries and would allow decision-makers to evaluate the effects of increased expenditure on overall population health.

Health systems face strong pressure to meet the needs of populations, but to do so with scarce resources. With a goal of providing universal health coverage, consideration must be paid to three aspects – who is covered, which services and provided and at what financial cost to the population. As a means of providing further information about the cost-effectiveness of healthcare provision, the authors have developed a framework to assess how adoption and coverage of new interventions will affect the rate of increase in healthcare expenditure and life expectancy at a population level. The model uses the metric of incremental cost-effectiveness ration (ICER) which expressed the efficiency of an intervention in terms of costs per unit of benefit or quality-adjusted life years (QALY). The relationship between the ICER of new interventions and the rate of increase in healthcare expenditure per capita and life expectancy at the country level is the basis for their estimation of cost-effectiveness thresholds for these interventions. Based on this ‘supply-side’ model, the cost-effectiveness thresholds for 174 countries per QALY were calculated and were less than 0.5 gross domestic product (GDP) per capita in 96% of low-income countries and in 76% of lower-middle-income countries, and less than 1 GDP in 168 (97%) of countries, which is the current WHO-derived threshold. The authors hope that utilization of a supply-side approach to evaluate cost-effectiveness in healthcare will allow for appropriate prioritization of expenditures and result in decreased health inequities.