Cited by 853Health Systems, Economic Evaluations, Quality of LifePharmaceutical Economics and PolicyGlobal Health Care Issues

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Thresholds for the cost–effectiveness of interventions: alternative approaches

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Marseille, Elliot, Larson, Bruce, Kazi, Dhruv S, Kahn, James G, Rosen, Sydney·2015·Bulletin of the World Health Organization

DOI 10.2471/blt.14.138206PMC PMC4339959

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Abstract

Many countries use the cost-effectiveness thresholds recommended by the World Health Organization's Choosing Interventions that are Cost-Effective project (WHO-CHOICE) when evaluating health interventions. This project sets the threshold for cost-effectiveness as the cost of the intervention per disability-adjusted life-year (DALY) averted less than three times the country's annual gross domestic product (GDP) per capita. Highly cost-effective interventions are defined as meeting a threshold per DALY averted of once the annual GDP per capita. We argue that reliance on these thresholds reduces the value of cost-effectiveness analyses and makes such analyses too blunt to be useful for most decision-making in the field of public health. Use of these thresholds has little theoretical justification, skirts the difficult but necessary ranking of the relative values of locally-applicable interventions and omits any consideration of what is truly affordable. The WHO-CHOICE thresholds set such a low bar for cost-effectiveness that very few interventions with evidence of efficacy can be ruled out. The thresholds have little value in assessing the trade-offs that decision-makers must confront. We present alternative approaches for applying cost-effectiveness criteria to choices in the allocation of health-care resources.

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Authors: Marseille, E., Larson, B., Kazi, D. S., Kahn, J. G., & Rosen, S.
Affiliations: Health Strategies International, 555 Fifty-ninth Street, Oakland, California, 94609, United States of America (USA).
Boston University (US)
San Francisco General Hospital (US)
University of California, San Francisco (US)
Corresponding author: Marseille, Elliot
ORCID: Marseille, Elliot
Larson, Bruce
Kazi, Dhruv S
Kahn, James G
Rosen, Sydney
Venue: Bulletin of the World Health Organization
Publisher: WHO Press
Published: 2014-12-15
Volume: 93
Issue: 2
Pages: 118-124
ISSN: 0042-9686 (ISSN-L)
DOI: 10.2471/blt.14.138206
PMC: PMC4339959
OpenAlex: W2133104890
Cited by: 851
References: 42
Citations by year: 2026: 45 · 2025: 68 · 2024: 58 · 2023: 69 · 2022: 93 · 2021: 101 · 2020: 100 · 2019: 105 · 2018: 76 · 2017: 78 · 2016: 40 · 2015: 18
FWCI: 112.73
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by
Locations: Bulletin of the World Health Organization (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
eScholarship (California Digital Library) (submittedVersion)
Funders: National Institute of Mental Health (P30MH062246)
National Institute on Drug Abuse (R01DA015612)
Topics: Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
Keywords: cost-effectiveness threshold, WHO-CHOICE, disability-adjusted life years, GDP per capita, healthcare resource allocation, public health decision-making, affordability, cost-effectiveness analysis
MeSH terms: Cost-Benefit Analysis, Developing Countries, Female, Health Priorities, Humans, Pregnancy, Syphilis, Global Health, World Health Organization, HIV Infections, Quality-Adjusted Life Years, Benchmarking, Anti-Retroviral Agents, Insecticide-Treated Bednets, Gross Domestic Product

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Thresholds for the cost–effectiveness of interventions: alternative approaches

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