Cost-effectiveness analysis is crucial for making informed decisions about healthcare investments. The World Health Organization (WHO), through its Choosing Interventions that are Cost-Effective (WHO-CHOICE) project, has been a global leader in this field for nearly two decades. This guide explores the WHO-CHOICE approach, highlighting its methodology, key findings, and resources available for conducting context-specific analyses.
The WHO-CHOICE approach provides a standardized methodology for evaluating the cost-effectiveness of various health interventions. This consistent methodology allows for fair comparisons across different disease areas and health programs, a major advantage of the approach. A recent update includes cost-effectiveness estimates for 479 intervention scenarios across 20 disease programs and risk factors. The analysis covers two regions: Eastern sub-Saharan Africa and Southeast Asia, with estimates presented at the regional level.
While these regional estimates are valuable, epidemiological structures, socioeconomic determinants, commodity prices, and healthcare workforce costs vary significantly across settings. This underscores the need for context-specific analysis at the country level. To support this, WHO-CHOICE has developed a downloadable tool for country users, known as the OneHealth tool.
Key Findings and Methodological Updates
The methods and results of WHO-CHOICE were formally released in November 2021 as a Special Issue on “The World Health Organization Choosing Interventions That Are Cost-Effective (WHO-CHOICE) Update” in the International Journal of Health Policy and Management. This special issue provides a comprehensive overview of the project’s latest findings and methodological advancements.
Further details can be found in five key papers:
1. Methods for the Economic Evaluation of Health Care Interventions
This paper, “Methods for the Economic Evaluation of Health Care Interventions for Priority Setting in the Health System: An Update From WHO CHOICE,” outlines the WHO-CHOICE approach as a “generalized” method for cost-effectiveness analysis. It serves as a quantitative assessment of current and future efficiency within a health system. This approach supports priority-setting processes, enabling health stewards to make informed decisions about resource allocation to maximize health gains. The 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 used in the models.
2. Cost-Effectiveness of Interventions for Maternal, Newborn and Child Health
The paper “Cost-effectiveness of interventions to improve maternal, newborn and child health outcomes: a WHO-CHOICE analysis for Eastern sub-Saharan Africa and South-East Asia” focuses on interventions within immunization, child healthcare, nutrition, reproductive health, and maternal/newborn health. It models the impact of these interventions on MNCH mortality outcomes using the Lives Saved Tool (LiST).
The analysis reveals that high-value interventions, such as family planning, neonatal resuscitation, management of pneumonia and neonatal infection, vitamin A supplementation, and measles vaccine, are consistent across the two regions studied. Given the persistently high rates of maternal and child mortality in many countries, these findings highlight opportunities to prioritize investments in high-impact interventions.
3. Priority Setting in HIV, Tuberculosis, and Malaria
“Priority Setting in HIV, Tuberculosis, and Malaria – New Cost-Effectiveness Results From WHO-CHOICE” demonstrates the high cost-effectiveness of prevention and treatment interventions for HIV, TB, and malaria. By retrospectively examining the achievements of program development and scaling up during the first decade of the 21st century (2000-2010), this analysis aims to guide policymakers in understanding what strategies yielded the most value for money in combating these diseases.
4. Cost-Effectiveness of Interventions to Combat Non-communicable Disease
This paper, “Cost-Effectiveness of Population Level and Individual Level Interventions to Combat Non-communicable Disease in Eastern Sub-Saharan Africa and South East Asia: A WHO-CHOICE Analysis,” estimates the cost-effectiveness of interventions for non-communicable diseases (NCDs) and mental health, including prevention, promotion, and management strategies. The analysis forms the basis for Appendix 3 of the Global Action Plan for NCDs, also known as WHO’s “best buys” for NCDs.
Many interventions for preventing and promoting NCD control, such as tobacco and alcohol control policies (e.g., taxation), voluntary and legislative actions to reduce sodium intake, and mass media campaigns for promoting physical activity, are highly cost-effective. Treatment options for cardiovascular disease (CVD), cervical cancer, and epilepsy also represent high value for money. However, the analysis reveals a gap in highly cost-effective interventions (less than $100 per healthy life year gained) for many NCDs and mental health disorders, highlighting the need for further research to reduce the costs of delivering these interventions.
5. Progressive Realisation of Universal Health Coverage
The paper “Progressive Realisation of Universal Health Coverage in Low- and Middle-Income Countries: Beyond the “Best Buys”” presents a cross-program analysis of the comparative cost-effectiveness of 479 intervention scenarios across 20 disease programs and risk factors. To develop an expansion pathway, all interventions are compared based on their average cost-effectiveness ratio. Step-wise increases of the service package are informed by incremental cost-effectiveness ratios. As the service package expands, the model calculates incremental health gains and additional costs, taking economies of scale into account. The optimal pathway across all disease areas indicates that a mix of interventions across different diseases should be included in the health benefit package in the two regions.
Conclusion
The WHO-CHOICE project provides invaluable resources and guidance for conducting cost-effectiveness analysis in healthcare. By utilizing its standardized methodology, data, and tools, decision-makers can make more informed choices about how to allocate resources and improve health outcomes globally. Utilizing the OneHealth tool enables countries to adapt global models to local contexts for improved decision making. The insights and evidence generated through WHO-CHOICE are essential for achieving universal health coverage and maximizing the impact of healthcare investments.
