What next after GDP-based cost-effectiveness thresholds?

Area of Science:

• Health economics
• Health policy
• Public health

Background:

• Public payers globally utilize cost-effectiveness thresholds (CETs) for healthcare intervention valuation and coverage.
• The widely used 1-3 GDP per capita threshold faces criticism and discouragement from organizations like the WHO.
• A need exists for reliable CETs to support Universal Health Coverage goals, especially in low- and middle-income countries.

Purpose of the Study:

• To address the confusion and provide practical alternatives to the 1-3 GDP per capita rule for CET formulation.
• To offer five actionable options for decision-makers in low- and middle-income countries.
• To guide the development of locally relevant CETs by combining evidence with decision-rules.

Main Methods:

• Literature review on cost-effectiveness thresholds.
• Engagement with experts and decision-makers from various income-level countries.
• Development of five practical options for CET formulation.

Main Results:

• The 1-3 GDP per capita rule is widely criticized and discouraged.
• Five alternative approaches are proposed for developing locally relevant CETs.
• These options facilitate the integration of existing evidence with fair decision-making processes.

Conclusions:

• The criticized 1-3 GDP per capita rule should be replaced with more appropriate methods.
• The proposed five practical options can guide policymakers in low- and middle-income countries.
• Developing locally relevant CETs is crucial for achieving Universal Health Coverage.