Evidence map›Paper›PMID 35227450›Full record

ReviewValue in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research2022

The Use of Cost-Effectiveness Thresholds for Evaluating Health Interventions in Low- and Middle-Income Countries From 2015 to 2020: A Review.

Joseph Kazibwe, Adrian Gheorghe, David Wilson, Francis Ruiz, Kalipso Chalkidou, Y-Ling Chi

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 78 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
78citing papers in PubMed, 13 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.

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

78 citing papers in PubMed, 13 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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  5. Cost Effectiveness of Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: A Systematic Review and Meta-analysis.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2025
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  7. Factors associated with the author-reported cost-effectiveness threshold in high-income countries: systematic review and multivariable modelling.The European journal of health economics : HEPAC : health economics in prevention and care · 2024
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18 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

6 authors.

Joseph KazibweGlobal Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK.
Adrian GheorgheGlobal Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK.
David WilsonBill & Melinda Gates Foundation, London, England, UK.
Francis RuizGlobal Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK.
Kalipso ChalkidouGlobal Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK.
Y-Ling ChiInternational Decision Support Initiative, Center for Global Development, London, England, UK. Electronic address: ychi@cgdev.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesEvidence-informed priority setting, in particular cost-effectiveness analysis (CEA), can help target resources better to achieve universal health coverage. Central to the application of CEA is the use of a cost-effectiveness threshold. We add to the literature by looking at what thresholds have been used in published CEA and the proportion of interventions found to be cost-effective, by type of threshold.

methodsWe identified CEA studies in low- and middle-income countries from the Global Health Cost-Effectiveness Analysis Registry that were published between January 1, 2015, and January 6, 2020. We extracted data on the country of focus, type of interventions under consideration, funder, threshold used, and recommendations.

resultsA total of 230 studies with a total 713 interventions were included in this review; 1 to 3× gross domestic product (GDP) per capita was the most common type of threshold used in judging cost-effectiveness (84.3%). Approximately a third of studies (34.2%) using 1 to 3× GDP per capita applied a threshold at 3× GDP per capita. We have found that no study used locally developed thresholds. We found that 79.3% of interventions received a recommendation as "cost-effective" and that 85.9% of studies had at least 1 intervention that was considered cost-effective. The use of 1 to 3× GDP per capita led to a higher proportion of study interventions being judged as cost-effective compared with other types of thresholds.

conclusionsDespite the wide concerns about the use of 1 to 3× GDP per capita, this threshold is still widely used in the literature. Using this threshold leads to more interventions being recommended as "cost-effective." This study further explore alternatives to the 1 to 3× GDP as a decision rule.

Indexed as

Developing CountriesCost-Benefit AnalysisDisability-Adjusted Life YearsGross Domestic ProductHumansWorld Health Organization1 to 3× gross domestic product per capitacost-effectiveness thresholdsdecision ruleslow- and middle-income countries

Identifiers

PMID35227450
PMCPMC8885424

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.