Systematic review of the impact of health care expenditure on health outcome measures: Implications for cost-effectiveness thresholds

TY - JOUR

T1 - Systematic review of the impact of health care expenditure on health outcome measures

T2 - Implications for cost-effectiveness thresholds

AU - Gloria, Mac Ardy Junio

AU - Thavorncharoensap, Montarat

AU - Chaikledkaew, Usa

AU - Youngkong, Sitaporn

AU - Thakkinstian, Ammarin

AU - Chaiyakunapruk, Nathorn

AU - Ochalek, Jessica

AU - Culyer, Anthony J.

N1 - Funding Information: This work had been part of the training in the Mahidol University Health Technology Assessment (MUHTA) program. Whereas the scholarship had been provided by the Mahidol University and the International Decision Support Initiative (iDSI). This work was produced as part of the International Decision Support Initiative ( www.idsihealth.org ) which supports countries to get the best value for money from health spending. iDSI receives funding support from the Bill & Melinda Gates Foundation, the UK Department for International Development, and the Rockefeller Foundation. The findings, interpretations and conclusions expressed in this article do not necessarily reflect the views of the aforementioned funding agencies. Publisher Copyright: © 2023 Informa UK Limited, trading as Taylor & Francis Group.

PY - 2024

Y1 - 2024

N2 - Objective: Empirical estimates of the impact of healthcare expenditure on health outcome measures may inform the cost-effectiveness threshold (CET) for guiding funding decisions. This study aims to systematically review studies that estimated this, summarize and compare the estimates by country income level. Methods: We searched PubMed, Scopus, York Research database, and [anonymized] for Reviews and Dissemination database from inception to 1 August 2023. For inclusion, a study had to be an original article, estimating the impact of healthcare expenditure on health outcome measures at a country level, and presented estimates, in terms of cost per quality-adjusted life year (QALY) or disability-adjusted life year (DALY). Results: We included 18 studies with 385 estimates. The median (range) estimates were PPP$ 11,224 (PPP$ 223–PPP$ 288,816) per QALY gained and PPP$ 5,963 (PPP$ 71–PPP$ 165,629) per DALY averted. As ratios of Gross Domestic Product per capita (GDPPC), these estimates were 0.376 (0.041–182.840) and 0.318 (0.004–37.315) times of GDPPC, respectively. Conclusions: The commonly used CET of GDPPC seems to be too high for all countries, but especially low-to-middle-income countries where the potential health losses from misallocation of the same money are greater. Registration: The review protocol was published and registered in PROSPERO (CRD42020147276).

AB - Objective: Empirical estimates of the impact of healthcare expenditure on health outcome measures may inform the cost-effectiveness threshold (CET) for guiding funding decisions. This study aims to systematically review studies that estimated this, summarize and compare the estimates by country income level. Methods: We searched PubMed, Scopus, York Research database, and [anonymized] for Reviews and Dissemination database from inception to 1 August 2023. For inclusion, a study had to be an original article, estimating the impact of healthcare expenditure on health outcome measures at a country level, and presented estimates, in terms of cost per quality-adjusted life year (QALY) or disability-adjusted life year (DALY). Results: We included 18 studies with 385 estimates. The median (range) estimates were PPP$ 11,224 (PPP$ 223–PPP$ 288,816) per QALY gained and PPP$ 5,963 (PPP$ 71–PPP$ 165,629) per DALY averted. As ratios of Gross Domestic Product per capita (GDPPC), these estimates were 0.376 (0.041–182.840) and 0.318 (0.004–37.315) times of GDPPC, respectively. Conclusions: The commonly used CET of GDPPC seems to be too high for all countries, but especially low-to-middle-income countries where the potential health losses from misallocation of the same money are greater. Registration: The review protocol was published and registered in PROSPERO (CRD42020147276).

KW - cost-effectiveness threshold

KW - opportunity cost

KW - supply-side method

KW - Systematic review

KW - threshold

UR - http://www.scopus.com/inward/record.url?scp=85180882369&partnerID=8YFLogxK

U2 - 10.1080/14737167.2023.2296562

DO - 10.1080/14737167.2023.2296562

M3 - Review article

C2 - 38112068

AN - SCOPUS:85180882369

SN - 1473-7167

VL - 24

SP - 203

EP - 215

JO - Expert Review of Pharmacoeconomics and Outcomes Research

JF - Expert Review of Pharmacoeconomics and Outcomes Research

IS - 2

ER -