World Health Organization Choosing Interventions that are Cost-Effective (WHO-CHOICE) has been a global leader in the field of economic evaluation, specifically cost-effectiveness analysis, for almost 20 years. The use of a consistent methodology across disease areas is a major added value of the CHOICE approach, as it allows for fair comparison between and across health programmes. A recent update presents cost-effectiveness estimates for 479 intervention scenarios across 20 disease programmes and risk factors. The analysis was run for two regions: Eastern sub-Saharan Africa and Southeast Asia, and estimates are presented at regional level. Across settings, there will be differences in epidemiological structure, related social and economic determinants, commodity prices, costs of health workforce and other inputs, that warrant the need for a context-specific analysis. For analysts and decision-makers wanting to create country-specific estimates, WHO-CHOICE has developed a downloadable tool that is freely available for country users (OneHealth tool).
The methods and results were formally released in November 2021 as a Special Issue on “The World Health Organization Choosing Interventions That Are Cost-Effective (WHO-CHOICE) Update”
More details are available in five papers:
The WHO-CHOICE approach is unique in the global health landscape, as it takes a “generalized” approach to cost-effectiveness analysis that can be seen as a quantitative assessment of current and future efficiency within a health system. This supports priority setting processes, ensuring that health stewards know how to spend resources in order to achieve the highest health gain as one consideration in strategic planning. This paper provides an overview of the methodological approach, highlighting updates to the analytic framework over the past 10 years, including strategic choices around time horizon and discount rates.
This paper presents cost-effectiveness for interventions that fall within the areas of immunization, child health care, nutrition, reproductive health, and maternal/newborn health, and for which it is possible to model impact on MNCH mortality outcomes using the Lives Saved Tool (LiST).
High value interventions are consistent across the two regions, and include family planning, neonatal resuscitation, management of pneumonia and neonatal infection, vitamin A supplementation, and measles vaccine. With maternal and child mortality still looming high in many countries, there are opportunities to gear investments towards high-impact interventions.
Priority Setting in HIV, Tuberculosis, and Malaria – New Cost-Effectiveness Results From WHO-CHOICE
The analysis demonstrates that HIV, TB and malaria prevention and treatment interventions are highly cost-effective. By retrospectively shining a spotlight on what programme development and scaling up achieved during the first decade of the 21st century (2000- 2010), it aims to assist policy-makers in understanding what worked in obtaining value for money for HIV, TB and malaria.
This paper estimates the cost-effectiveness for a set of non-communicable disease and mental health interventions, including both prevention and promotion as well as management interventions. The analysis presented in this paper underpins the current Appendix 3 of the Global Action Plan for NCDs, otherwise known as WHO’s “best buys” for NCDs. Many interventions for prevention and promotion of NCDs are highly cost-effective. These include tobacco and alcohol control policies such as taxation, voluntary and legislative actions to reduce sodium intake, mass media campaigns for reducing physical activity. Treatment options for cardiovascular disease (CVD), cervical cancer and epilepsy also represent high value for money. However the analysis shows that for many NCD and mental health disorders we still do not have interventions failing into the highly cost-effective less than $100 per healthy life year gained category. More needs to be done to reduce the costs of delivering these interventions.
This paper presents for the first time a cross-programme analysis of the comparative cost-effectiveness of 479 intervention scenarios across 20 disease programmes and risk factors. In order to develop an expansion pathway, all interventions are compared in terms of average cost-effectiveness ratio. Step-wise increases of the package are informed by incremental cost-effectiveness ratios. As the service package is expanded, the model calculates incremental health gains and additional costs (taking economies of scale into account). Developing the mathematically optimal pathway across all disease areas indicates that a mix of diseases would have interventions falling into the health benefit package in the two regions.