Estimating International CostEffectiveness Thresholds to Reflect
Opportunity Costs
Mark Sculpher, PhD
Professor of Health Economics
Centre for Health Economics
University of York, UK
ISPOR, Santiago 2015. Issues Panel: ‘Changing the History of
Cost-Effectiveness Decision Rules’
Acknowledgements
• International Decision Support Initiative (iDSI) is funded
by the Bill and Melinda Gates Foundation, UK
Department for International Development
• Acknowledgements to Karl Claxton, Beth Woods, Paul
Revill, Jessica Ochalek, James Lomas
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International estimates of cost-effectiveness
thresholds
• Decision makers need to understand opportunity costs
of new funding decisions
• Can we see as ‘supply side’ cost-effectiveness
threshold
• UK work being replicated in other countries
– But time consuming and requires data
• How can we inform decisions in the absence of these
studies
• Two approaches explored in current work
Estimating supply side thresholds internationally
http://www.york.ac.uk/media/che/docu
ments/papers/researchpapers/CHER
P109_costeffectiveness_threshold_LMICs.pdf
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Extrapolation from UK estimates
Evidence
Assumptions
• UK estimate of opportunity cost
threshold (k)
• UK threshold 0.56 GDPpc
• Estimates of elasticity of v with
respect to countries’ per capita
income
• k and willingness to pay (v)
discrepancy (%) in UK
generalisable
• v can be proxied by the value of a
statistical life
• UK ‘typical’ of other countries with
regarding values of v and k
• income elasticity of VSL = income
elasticity of the consumption
value of a QALY
Estimates
L/MIC = 2% - 56%
M/HIC = 20% - 77%
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Using cross country data on expenditure and mortality
Cost per DALY estimates based on Bokhari et al (2007)
YLL
scaled up
mortality
estimates
YLD
directly
estimated
DALY
ratio of YLD to YLL
in the population directly estimated
DALY 1
X
X
amended DALY 1
X
X
directly
estimated DALY
X
DALY 2
X
X
amended DALY 2
X
X
DALY 3
X
X
amended DALY 3
X
X
DALY 4
adjusted for
morbidity
X
X
X
4
Cost per DALY averted (all countries)
Cost per DALY averted (middle income countries)
5
Cost per DALY averted (lower middle income countries)
Cost per DALY averted (upper middle income
countries)
6
Cost per DALY averted (high income countries)
7