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Progressive Realisation of Universal Health Coverage in Low- and Middle-Income Countries: Beyond the "Best Buys"
Melanie Y Bertram1, Jeremy A Lauer1, Karin Stenberg1
1Health Systems Governance and Financing, World Health Organization (WHO), Geneva, Switzerland.
International Journal of Health Policy and Management
|February 23, 2021
Summary
The World Health Organization (WHO) Choosing Interventions that are Cost-Effective (CHOICE) program analyzed 479 health interventions. High-impact, cost-effective interventions are often delivered through primary care services.
Area of Science:
- Global Health Economics
- Health Policy Analysis
- Intervention Cost-Effectiveness
Background:
- The World Health Organization (WHO) Choosing Interventions that are Cost-Effective (CHOICE) program has been active for 20 years.
- This study presents a novel cross-programme analysis of 479 intervention scenarios across 20 disease programs and risk factors.
Purpose of the Study:
- To conduct a comparative cost-effectiveness analysis of a wide range of health interventions.
- To inform the optimization of health benefit packages for universal health coverage (UHC).
Main Methods:
- Generalized cost-effectiveness analysis following the standard WHO CHOICE approach.
- Analysis applied to Eastern sub-Saharan Africa and Southeast Asia, using WHO treatment guidelines.
- Costs in 2010 international dollars, benefits modeled for 100 years from 2010.
Main Results:
- Intervention cost-effectiveness ratios varied significantly across analyzed scenarios.
- Optimized health benefit packages incorporate interventions addressing major disease burden drivers.
- Primary care (clinical and non-clinical) interventions constitute the majority of highly cost-effective options.
Conclusions:
- Cost-effectiveness is a key, but not the sole, criterion for selecting health interventions for UHC.
- Calculations require adaptation to local contexts for effective decision-making.
- The WHO CHOICE program offers a downloadable tool to aid country decision-makers in cost-effectiveness analysis.
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