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. 2017 Aug 10;12(8):e0182951.
doi: 10.1371/journal.pone.0182951. eCollection 2017.

Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness

Susan Horton  1 , Hellen Gelband  2 , Dean Jamison  3 , Carol Levin  3 , Rachel Nugent  4 , David Watkins  3
Affiliations

Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness

Susan Horton et al. PLoS One. .

Abstract

Background: Cost-effectiveness rankings of health interventions are useful inputs for national healthcare planning and budgeting. Previous comprehensive rankings for low- and middle- income countries were undertaken in 2005 and 2006, accompanying the development of strategies for the Millennium Development Goals. We update the rankings using studies published since 2000, as strategies are being considered for the Sustainable Development Goals.

Methods: Expert systematic searches of the literature were undertaken for a broad range of health interventions. Cost-effectiveness results using Disability Adjusted Life-Years (DALYs) as the health outcome were standardized to 2012 US dollars.

Results: 149 individual studies of 93 interventions qualified for inclusion. Interventions for Reproductive, Maternal, Newborn and Child Health accounted for 37% of interventions, and major infectious diseases (AIDS, TB, malaria and neglected tropical diseases) for 24%, consistent with the priorities of the Millennium Development Goals. More than half of the interventions considered cost less than $200 per DALY and hence can be considered for inclusion in Universal Health Care packages even in low-income countries.

Discussion: Important changes have occurred in rankings since 2006. Priorities have changed as a result of new technologies, new methods for changing behavior, and significant price changes for some vaccines and drugs. Achieving the Sustainable Development Goals will require LMICs to study a broader range of health interventions, particularly in adult health. Some interventions are no longer studied, in some cases because they have become usual care, in other cases because they are no longer relevant. Updating cost-effectiveness rankings on a regular basis is potentially a valuable exercise.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Interventions for adults costing less than $100 per DALY averted.
Fig 2
Fig 2. Interventions for adults costing between $100 and $999 per DALY averted.
* denotes outcome in QALYs ** denotes context is primary care, UMIC.
Fig 3
Fig 3. Interventions for adults costing $1000 or more per DALY averted.
* denotes outcome in QALYs.
Fig 4
Fig 4. Interventions for children.
* denotes outcome in QALYs.
See this image and copyright information in PMC

References

    1. Vos T, Carter R, Barendregt J, Mihalopoulos et al. Assessing Cost-Effectiveness in Prevention. University of Queensland. https://public-health.uq.edu.au/filething/get/1836/ACE-Prevention_final_... (accessed June 30, 2016).
    1. Greenberg D, Earle C, Fang CH, Eldar-Lissai A, Neumann PJ. When Is Cancer Care Cost-Effective? A Systematic Overview of Cost-Utility Analyses in Oncology. J Natl Cancer Inst 2010; 102: 82–88. doi: 10.1093/jnci/djp472 - DOI - PMC - PubMed
    1. Salomon JA, Carvalho N, Gutiérrez-Delgado C et al. Intervention strategies to reduce the burden of non—communicable diseases in Mexico: cost effectiveness analysis. BMJ 2012; 344: e355 doi: 10.1136/bmj.e355 - DOI - PMC - PubMed
    1. Evans DB, Lim SS, Adam T, Tan-Torres Edejer T. Achieving the millennium development goals for health: Evaluation of current strategies and future priorities for improving health in developing countries. BMJ 2005; 331: 1457–1461. - PMC - PubMed
    1. Laxminarayan R, Chow J, Shahid-Solles SA. Intervention Cost-Effectiveness: Overview of Main Messages In Jamison DT, Alleyne G, Breman J et al. , eds, Disease Control Priorities in Developing Countries (2nd ed.), New York: Oxford University Press, 2006: 35–86.