Evidence map›Paper›PMID 27994285›Full record

ArticleBulletin of the World Health Organization2016

Cost-effectiveness thresholds: pros and cons.

Melanie Y Bertram, Jeremy A Lauer, Kees De Joncheere, Tessa Edejer, Raymond Hutubessy, Marie-Paule Kieny, Suzanne R Hill

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Bulletin of the World Health Organization, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 408 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
408citing papers in PubMed, 14 pooled it
225.0field-weighted citation impact, top 1% of its field
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

408 citing papers in PubMed, 14 syntheses or guidelines pooled it, 775 citations in OpenAlex.

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348 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

7 authors at 1 institution in 1 country.

Melanie Y BertramWorld Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland .
Jeremy A LauerWorld Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland .
Kees De JoncheereWorld Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland .
Tessa EdejerWorld Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland .
Raymond HutubessyWorld Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland .
Marie-Paule KienyWorld Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland .
Suzanne R HillWorld Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland .
World Health Organization · CH

Funding

World Health Organization 001
6 · The paper itself

Abstract

Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

Indexed as

BudgetsCost-Benefit AnalysisDecision MakingGlobal HealthGross Domestic ProductHumansWorld Health Organization

Identifiers

PMID27994285
PMCPMC5153921
OpenAlexW2557867537

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.