Cost-Effectiveness

The Cost-Effectiveness Work Group currently carries out research directly related to the Disease Control Priorities Network project. IHME’s aim is to produce a set of highly comparable cost-effectiveness assessments for more than 300 interventions and a multitude of health service delivery platforms in each of the 21 Global Burden of Disease (GBD) regions. Many of the existing cost-effectiveness estimates available to policymakers use widely differing assumptions about both costs and effectiveness that in turn make it difficult to truly compare results attained in different studies. Additionally, the focus is almost exclusively on interventions, ignoring the actual health service delivery platforms – the conduits through which health interventions and public health measures are implanted (e.g., hospitals, community health clinics). By conducting cost-effectiveness assessments of these platforms as well, IHME will provide policymakers with the ability to understand the trade-offs between different implementation routes for the same intervention.

Major activities in Cost-Effectiveness:

Define a list of interventions to be investigated:

There have been several previous significant efforts to compile cost-effectiveness estimates for a slate of interventions. These include the World Health Organization’s Choosing Interventions that are Cost-Effective (CHOICE) program and two previous Disease Control Priorities projects carried out by a combination of the World Bank, the WHO, and the National Institutes of Health’s Fogarty International Center. The new Disease Control Priorities Network project intends to identify the primary interventions associated with each of the diseases, risk factors, injuries, and resulting conditions examined in the Global Burden of Diseases Study 2010. In addition, researchers must consider variations of intervention availability and choice among the 21 GBD regions.

Develop a typology of health service delivery platforms:

Previous cost-effectiveness efforts have not given consideration to the mode of delivery of interventions – in other words, the health service delivery platform. This creates a gap in critical information for policymakers, who frequently must make decisions about not just funding specific interventions, but on how best to deploy them. Previous efforts have largely focused on assessing individual interventions, often in isolation, such as antiretroviral drugs (ARVs) for HIV. Just as important to policymakers is how to distribute ARVs and ensure adherence so they are effective. Should they distribute them through hospitals, or are community health centers more effective at reaching dispersed populations? Is better adherence achieved through training community health workers to make household visits, or by creating a systems infrastructure for testing and tracking viral loads? Policymakers must weigh the trade-offs and effectiveness of targeting quality improvement, infrastructure, delivery, services expansion, and focused interventions. To begin this research path, IHME is first defining the health service delivery platforms it will target before gathering cost data on each of them.

Develop a standard protocol for conducting cost-effectiveness studies:

To ensure comparable and consistent results, each of the cost-effectiveness studies must be governed by a commonly implemented protocol. Real population effectiveness will be strongly influenced by variation in household demand for and access to health care services, provider quality, and patient adherence. Evidence on these dimensions of effectiveness is often weak, creating considerable disagreements among analysts. Problems also arise in the estimation of externalities or long-term effects using disease transmission and natural history models. Models for the same disease, generated by different experts, produce highly varied results based upon a myriad of assumptions. These differences highlight the need for systematic standardization of approaches and clarity about assumptions.

Carry out the cost-effectiveness assessment of select interventions and platforms:

IHME is beginning to carry out assessments of select interventions to test hypotheses about the best methods. Lessons learned from these initial assessments will be used to help define overall cost-effectiveness guidelines and to scale up the DCPN project over time to encompass more than 300 interventions and a variety of health service delivery platforms in different regions of the world.

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