Why cost-effectiveness thresholds for global health donors differ from thresholds for Ministries of Health (and why it matters)

Drake, Tom and Chi, Y-Ling and Morton, Alec and Pitt, Catherine (2023) Why cost-effectiveness thresholds for global health donors differ from thresholds for Ministries of Health (and why it matters). F1000Research, 12. 214. ISSN 2046-1402 (https://doi.org/10.12688/f1000research.131230.1)

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Abstract

Healthcare cost-effectiveness analysis is increasingly used to inform priority-setting in low- and middle-income countries and by global health donors. As part of such analyses, cost-effectiveness thresholds are commonly used to determine what is, or is not, cost-effective. Recent years have seen a shift in best practice from a rule-of-thumb 1x or 3x per capita GDP threshold towards using thresholds that, in theory, reflect the opportunity cost of new investments within a given country. In this paper, we observe that international donors face both different resource constraints and opportunity costs compared to national decision makers. Hence, their perspective on cost-effectiveness thresholds must be different. We discuss the potential implications of distinguishing between national and donor thresholds and outline broad options for how to approach setting a donor-perspective threshold. Further work is needed to clarify healthcare cost-effectiveness threshold theory in the context of international aid and to develop practical policy frameworks for implementation.

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