15. Cost–Effectiveness Analysis for Priority Setting

Abstract

There are some common features and some variations of economic analysis in disease control. The current methods have some weaknesses that could be addressed in the future.

Cost–effectiveness analysis, the principal analytic tool, compares the cost of an intervention with the expected health gains. An intervention is any activity using human, physical, or financial resources in a deliberate attempt to improve health by reducing the risk, duration, or severity of a health problem.

All analyses start with some natural unit (for example, cases of disease or deaths, or numbers of people who adopt a health–improving behavior) for measuring outcomes. When lives are saved at different ages, some measure is used to account for differences in years of life saved. Discounting is used to reflect inherent uncertainty about the future and preferences for timing of cists and benefits.

The effectiveness of an intervention is measured according to a disability–adjusted life year (DALY) or quality–adjusted life year (QALY). No systemic formula exists for converting between DALYs and QALYs, but it may be possible to rank the cost–effectiveness of interventions evaluated by the differing methods.

Analyses could be improved by more and better data from low– and middle–income countries to reduce reliance on extrapolation from high–income countries and expert judgments. More use of analytic models would allow for testing of hypotheses about interventions, as well as help to identify gaps in current evidence and capturing details specific to particular populations and settings. Modeling encourages explicit decision making and avoids over–reliance on assumptions.