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. 2024 Jan 18:12:214.
doi: 10.12688/f1000research.131230.2. eCollection 2023.

Why cost-effectiveness thresholds for global health donors should differ from thresholds for Ministries of Health (and why it matters)

Tom Drake  1 , Y-Ling Chi  1 , Alec Morton  2 , Catherine Pitt  3
Affiliations

Why cost-effectiveness thresholds for global health donors should differ from thresholds for Ministries of Health (and why it matters)

Tom Drake et al. F1000Res. .

Abstract

Healthcare cost-effectiveness analysis is increasingly used to inform priority-setting in low- and middle-income countries and by global health donors. As part of such analyses, cost-effectiveness thresholds are commonly used to determine what is, or is not, cost-effective. Recent years have seen a shift in best practice from a rule-of-thumb 1x or 3x per capita GDP threshold towards using thresholds that, in theory, reflect the opportunity cost of new investments within a given country. In this paper, we observe that international donors face both different resource constraints and opportunity costs compared to national decision-makers. Hence, their perspective on cost-effectiveness thresholds must be different. We discuss the potential implications of distinguishing between national and donor thresholds and outline broad options for how to approach setting a donor-perspective threshold. Further work is needed to clarify healthcare cost-effectiveness threshold theory in the context of international aid and to develop practical policy frameworks for implementation.

Keywords: Global health; aid; cost-effectiveness; health financing; priority-setting; threshold.

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Conflict of interest statement

No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. National and donor cost-effectiveness thresholds using the bookshelf metaphor.
See this image and copyright information in PMC

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