Format

Send to

Choose Destination
Pharmacoeconomics. 2009;27(11):903-17. doi: 10.2165/10899580-000000000-00000.

Cost effectiveness in low- and middle-income countries: a review of the debates surrounding decision rules.

Author information

1
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. samuel.shillcutt@gmail.com

Abstract

Cost-effectiveness analysis (CEA) is increasingly important in public health decision making, including in low- and middle-income countries. The decision makers' valuation of a unit of health gain, or ceiling ratio (lambda), is important in CEA as the relative value against which acceptability is defined, although values are usually chosen arbitrarily in practice. Reference case estimates for lambda are useful to promote consistency, facilitate new developments in decision analysis, compare estimates against benefit-cost ratios from other economic sectors, and explicitly inform decisions about equity in global health budgets. The aim of this article is to discuss values for lambda used in practice, including derivation based on affordability expectations (such as $US150 per disability-adjusted life-year [DALY]), some multiple of gross national income or gross domestic product, and preference-elicitation methods, and explore the implications associated with each approach. The background to the debate is introduced, the theoretical bases of current values are reviewed, and examples are given of their application in practice. Advantages and disadvantages of each method for defining lambda are outlined, followed by an exploration of methodological and policy implications.

PMID:
19888791
PMCID:
PMC2810517
DOI:
10.2165/10899580-000000000-00000
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Springer Icon for PubMed Central
Loading ...
Support Center