Estimating a cost-effectiveness threshold for health care decision-making in South Africa
Estimating a cost-effectiveness threshold for health care decision-making in South Africa
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DOI：
10.1093/heapol/czz152
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发表时间：
2020-06-01
影响因子：
3.2
通讯作者：
Stacey, Nicholas K.
中科院分区：
文献类型：
--
作者：
Edoka, Ijeoma P.;Stacey, Nicholas K.
成本效益阈值是决定卫生干预措施是否物有所值的重要决策规则。在低收入和中等收入国家，世界卫生组织（世卫组织）所避免的每个残疾调整生命年（DALYs）的人均国内生产总值（GDP）的1至3倍一直是为资源分配决策提供信息的最广泛使用的门槛。然而，2016年，世卫组织撤回了使用这一阈值的建议，在南非和许多依赖成本效益分析结果做出资源分配决策的国家造成了巨大的真空。本研究采用三步法估计了反映南非卫生支出的卫生机会成本的成本效益阈值。首先，使用固定效应估计方法估计卫生支出边际收益为粗死亡率的卫生支出弹性。其次，估计了卫生支出的机会成本，避免了DALYs。最后，估计每个DALY避免阈值的成本是卫生支出边际产品的倒数。我们发现，2015年卫生总支出的1%（相当于约15.4亿兰特/ 1.207亿美元）避免了1050例死亡，34 180年的生命损失，5880年的残疾和40 055年的残疾生活。成本效益阈值估计约为3.85万南非兰特（3015美元），相当于2015年南非人均GDP的53%（7.72万南非兰特/ 5700美元），低于之前建议的人均GDP的1至3倍。随着南非朝着到2025年通过国家健康保险实施全民健康覆盖改革的目标迈进，采用反映卫生机会成本的门槛对于确保稀缺资源的有效分配至关重要。这项研究对南非卫生支出的卫生机会成本的大小提供了有用的见解，并强调了进一步研究的必要性。
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, similar to 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.