Evidence map›Paper›PMID 25883405›Full record

ArticleBulletin of the World Health Organization2015

Thresholds for the cost-effectiveness of interventions: alternative approaches.

Elliot Marseille, Bruce Larson, Dhruv S Kazi, James G Kahn, Sydney Rosen

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Bulletin of the World Health Organization, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03934931 (Options for Delivering Isoniazid-Rifapentine), which is not on this map. Cited by 452 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
452citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03934931 nacompletednot on this mapstarted 2020, after this paper: background citation

Options for Delivering Isoniazid-Rifapentine (3HP) for TB Prevention: the 3HP Options Implementation Trial

TypeinterventionalSponsorUniversity of California, San FranciscoRan2020 to 2025Enrolled1,656ConditionsTuberculosis, Latent Tuberculosis, HIV/AIDSArmsStreamlined weekly DOT visits, Weekly DOT visit reminders, Cost reimbursement DOT, 99DOTS, Weekly SAT dosing reminders/check-ins
3 · Its place in the literature

Who cites it

452 citing papers in PubMed, 10 syntheses or guidelines pooled it.

  1. Cost-effectiveness of specialized trauma care: A systematic review.Journal of health services research & policy · 2026
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  19. Cost-effectiveness of the MitraClip device in German heart failure patients with secondary mitral regurgitation.The European journal of health economics : HEPAC : health economics in prevention and care · 2023
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392 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Elliot MarseilleHealth Strategies International, 555 Fifty-ninth Street, Oakland, California, 94609, United States of America (USA).
Bruce LarsonCenter for Global Health and Development, Boston University, Boston, USA .
Dhruv S KaziDivision of Cardiology, San Francisco General Hospital, San Francisco, USA .
James G KahnInstitute for Health Policy Studies, University of California - San Francisco, San Francisco, USA .
Sydney RosenCenter for Global Health and Development, Boston University, Boston, USA .

Funding

Ujima Mentoring ProgramP30MH062246 · NIMH · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Sheri Ann Lippman · 2001 to 2026
$57.4M
Making Better Decisions: Policy Modeling for AIDS and Drug AbuseR01DA015612 · NIDA · STANFORD UNIVERSITY · PI OWENS, DOUGLAS K · 2002 to 2017
$9.4M
NIDA NIH HHS R01 DA015612NIMH NIH HHS P30 MH062246
6 · The paper itself

Abstract

Many countries use the cost-effectiveness thresholds recommended by the World Health Organization's Choosing Interventions that are Cost-Effective project (WHO-CHOICE) when evaluating health interventions. This project sets the threshold for cost-effectiveness as the cost of the intervention per disability-adjusted life-year (DALY) averted less than three times the country's annual gross domestic product (GDP) per capita. Highly cost-effective interventions are defined as meeting a threshold per DALY averted of once the annual GDP per capita. We argue that reliance on these thresholds reduces the value of cost-effectiveness analyses and makes such analyses too blunt to be useful for most decision-making in the field of public health. Use of these thresholds has little theoretical justification, skirts the difficult but necessary ranking of the relative values of locally-applicable interventions and omits any consideration of what is truly affordable. The WHO-CHOICE thresholds set such a low bar for cost-effectiveness that very few interventions with evidence of efficacy can be ruled out. The thresholds have little value in assessing the trade-offs that decision-makers must confront. We present alternative approaches for applying cost-effectiveness criteria to choices in the allocation of health-care resources.

Indexed as

Global HealthWorld Health OrganizationAnti-Retroviral AgentsBenchmarkingCost-Benefit AnalysisDeveloping CountriesFemaleGross Domestic ProductHealth PrioritiesHIV InfectionsHumansInsecticide-Treated BednetsPregnancyQuality-Adjusted Life YearsSyphilisAnti-Retroviral Agents

Identifiers

PMID25883405
PMCPMC4339959

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.