ArticleHealth policy and planning2020
Estimating a cost-effectiveness threshold for health care decision-making in South Africa.
Article in Health policy and planning, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 77 papers, 2 of them syntheses that pooled it.
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Who cites it
77 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Economic evaluation of psychological treatments for common mental disorders in low- and middle-income countries: a systematic review.Health policy and planning · 2023Pooled it
- Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2021Pooled it
- Stepped care to optimize pre-exposure prophylaxis (PrEP) effectiveness in pregnant and postpartum women (SCOPE-PP) in South Africa: a randomized control trial.BMC public health · 2022Trial
- Optimizing pneumococcal prevention in South African older adults: Cost-effectiveness of PCV20 versus PPSV23 in the context of HIV-associated risk.Human vaccines & immunotherapeutics · 2026Article
- Cost-Effectiveness of Reducing HIV Infections Through Screening and Treating Alcohol Use and Depression in KwaZulu-Natal, South Africa: A Mathematical Modeling Study.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- Cost-effectiveness and cost-utility of antenatal sexually transmitted infection screening to reduce preterm birth and low birthweight in South Africa.medRxiv : the preprint server for health sciences · 2026Article
- Cost-effectiveness of community tuberculosis screening in South Africa.American journal of respiratory and critical care medicine · 2026Article
- Cost-effectiveness and cost-utility of COVID-19 vaccination in a South African privately insured population: a real-world claims-based analysis.BMC health services research · 2026Article
- Quality-Adjusted Life Expectancy and Cost-Effectiveness Thresholds in Three High-Income Regions in Asia.Applied health economics and health policy · 2026Article
- Cost Effectiveness of First-Line Therapies for Treatment-Naïve Chronic Lymphocytic Leukaemia in South Africa.Clinical drug investigation · 2026Article
- Component Clinical and Cost Outcomes Complementing Value of Information: Case Study of a Tuberculosis Diagnostics Clinical Trial.PharmacoEconomics · 2026Review
- Potential long-acting tuberculosis treatment for people with HIV: cost-effectiveness benchmarks.Annals of the American Thoracic Society · 2026Article
- Economic Evaluation of Bruton's Tyrosine Kinase Inhibitors for Chronic Lymphocytic Leukaemia in South Africa.Applied health economics and health policy · 2026Article
- Article
- Oral iron supplementation as a public health intervention in children aged 6 to 23 months for preventing iron deficiency and anaemia: Economic evaluation for the South African health system.African journal of primary health care & family medicine · 2026Article
- Optimizing drug-resistant tuberculosis diagnosis: cost-effectiveness of rapid molecular and phenotypic assays in South Africa.BMC medicine · 2026Article
- Projected population level impact and cost-effectiveness of clinic and community-based tuberculosis screening approaches.PLOS global public health · 2026Article
- Costs and cost-effectiveness of community health worker programmes focussed on non-communicable diseases in low- and middle-income countries (2015-2024): a scoping literature review.BMJ global health · 2025Article
- Beyond cost-effectiveness: a reflective commentary on adapting global health technology assessment for equity considerations in South Africa and other LMICs.International journal for equity in health · 2025Article
- Cost-effectiveness analysis in primary care research: A practical guide for early-career researchers.African journal of primary health care & family medicine · 2025Article
17 more citing papers are in PubMed but not listed here.
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2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Cost-effectiveness thresholds are important decision rules that determine whether health interventions represent good value for money. In low- and middle-income countries, the World Health Organization (WHO) one to three times per capita gross domestic product (GDP) per disability-adjusted life years (DALYs) averted has been the most widely used threshold for informing resource allocation decisions. However, in 2016, the WHO withdrew recommendations for using this threshold, creating a significant vacuum in South Africa and many countries that rely on results of cost-effectiveness analyses for making resource allocation decisions. This study estimates a cost-effectiveness threshold that reflects the health opportunity cost of health spending in South Africa using a three-step approach. First, marginal returns to health spending was estimated as health spending elasticity for crude death rates using a fixed effect estimation approach. Second, the opportunity cost of health spending was estimated as DALYs averted. Finally, a cost per DALY averted threshold was estimated as the inverse of the marginal product of health spending. We show that 1% of total health spending in 2015 (equivalent to approximately ZAR 1.54 billion/USD 120.7 million) averted 1050 deaths, 34 180 years of life lost, 5880 years lived with disability and 40 055 DALYs. The cost-effectiveness threshold was estimated at approximately ZAR 38 500 (USD 3015) per DALY averted, ∼53% of South Africa's per capita GDP in 2015 (ZAR 72 700/USD 5700) and lower than the previously recommended one to three times per capita GDP. As South Africa moves towards implementing universal health coverage reforms through National Health Insurance by 2025, the adoption of a threshold that reflects health opportunity costs will be crucial for ensuring efficiency in the allocation of scarce resources. This study provides useful insight into the magnitude of the health opportunity cost of health spending in South Africa and highlights the need for further research.
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