When should global health actors prioritise more uncertain interventions?

Area of Science:

• Health Economics
• Global Health Policy
• Decision Science

Background:

• Economic evaluations, such as cost-effectiveness analyses, guide global health funding decisions.
• Difficulty in obtaining reliable cost-effectiveness estimates leads organizations to favor interventions with predictable efficacy.
• A prevalent risk-averse approach favors certainty over potentially higher-impact, less-studied interventions.

Purpose of the Study:

• To challenge the practice of risk aversion in global health funding based on intervention certainty.
• To advocate for a more nuanced approach to uncertainty in economic evaluations for global health.
• To identify considerations for funding highly uncertain but potentially impactful interventions.

Main Methods:

• Conceptual analysis of risk aversion in global health economic evaluations.
• Argumentation based on the potential trade-offs between certainty and health benefits.
• Discussion of factors influencing decision-making under uncertainty.

Main Results:

• Prioritizing certainty may lead to overlooking interventions with greater potential health gains.
• Risk aversion can result in neglecting less-studied populations and upstream health determinants.
• A tendency to favor certainty can hinder support for promising, complex interventions and crucial impact evaluations.

Conclusions:

• Global health actors should adopt more flexible attitudes towards uncertainty in funding decisions.
• Willingness to fund highly uncertain interventions is crucial in specific contexts.
• A framework for considering uncertainty in economic evaluations is needed to optimize global health investments.