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How much might a society spend on life-saving interventions at different ages while remaining cost-effective? A case study in a country with detailed data.

Kvizhinadze G, Wilson N, Nair N, McLeod M, Blakely T - Popul Health Metr (2015)

Bottom Line: These results were predictably very sensitive to the choice of discount rate and to the selected cost-effectiveness threshold.We present an approach to estimating maximal cost-effective investment in life-saving health interventions, under various assumptions.Policymakers could use these estimates as a rapid screening tool to determine if more detailed cost-effectiveness analyses of potential life-saving interventions might be worthwhile or which proposed life-saving interventions are very unlikely to benefit from such additional research.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington New Zealand.

ABSTRACT

Objective: We aimed to estimate the maximum intervention cost (EMIC) a society could invest in a life-saving intervention at different ages while remaining cost-effective according to a user-specified cost-effectiveness threshold.

Methods: New Zealand (NZ) was used as a case study, and a health system perspective was taken. Data from NZ life tables and morbidity data from a burden of disease study were used to estimate health-adjusted life-years (HALYs) gained by a life-saving intervention. Health system costs were estimated from a national database of all publicly funded health events (hospitalizations, outpatient events, pharmaceuticals, etc.). For illustrative purposes we followed the WHO-CHOICE approach and used a cost-effectiveness threshold of the gross domestic product (GDP) per capita (NZ$45,000 or US$30,000 per HALY). We then calculated EMICs for an "ideal" life-saving intervention that fully returned survivors to the same average morbidity, mortality, and cost trajectories as the rest of their cohort.

Findings: The EMIC of the "ideal" life-saving intervention varied markedly by age: NZ$1.3 million (US$880,000) for an intervention to save the life of a child, NZ$0.8 million (US$540,000) for a 50-year-old, and NZ$0.235 million (US$158,000) for an 80-year-old. These results were predictably very sensitive to the choice of discount rate and to the selected cost-effectiveness threshold. Using WHO data, we produced an online calculator to allow the performance of similar calculations for all other countries.

Conclusions: We present an approach to estimating maximal cost-effective investment in life-saving health interventions, under various assumptions. Our online calculator allows this approach to be applied in other countries. Policymakers could use these estimates as a rapid screening tool to determine if more detailed cost-effectiveness analyses of potential life-saving interventions might be worthwhile or which proposed life-saving interventions are very unlikely to benefit from such additional research.

No MeSH data available.


Estimated maximum intervention cost to save a life, at NZ$45,000 cost-effectiveness threshold, for three different discount rates
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Fig1: Estimated maximum intervention cost to save a life, at NZ$45,000 cost-effectiveness threshold, for three different discount rates

Mentions: The EMIC to save a life for the ideal intervention (100 % fatal without intervention, 100 % effective intervention, no ongoing morbidity, mortality risk, or cost increase following intervention) varied markedly by age. Using a 3 % discount rate, the EMIC was NZ$1.3 million to save the life of a child, $0.8 million to save the life of a 50-year-old, and $0.235 million to save the life of an 80-year-old (Fig. 1, Table 1).Fig. 1


How much might a society spend on life-saving interventions at different ages while remaining cost-effective? A case study in a country with detailed data.

Kvizhinadze G, Wilson N, Nair N, McLeod M, Blakely T - Popul Health Metr (2015)

Estimated maximum intervention cost to save a life, at NZ$45,000 cost-effectiveness threshold, for three different discount rates
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4493819&req=5

Fig1: Estimated maximum intervention cost to save a life, at NZ$45,000 cost-effectiveness threshold, for three different discount rates
Mentions: The EMIC to save a life for the ideal intervention (100 % fatal without intervention, 100 % effective intervention, no ongoing morbidity, mortality risk, or cost increase following intervention) varied markedly by age. Using a 3 % discount rate, the EMIC was NZ$1.3 million to save the life of a child, $0.8 million to save the life of a 50-year-old, and $0.235 million to save the life of an 80-year-old (Fig. 1, Table 1).Fig. 1

Bottom Line: These results were predictably very sensitive to the choice of discount rate and to the selected cost-effectiveness threshold.We present an approach to estimating maximal cost-effective investment in life-saving health interventions, under various assumptions.Policymakers could use these estimates as a rapid screening tool to determine if more detailed cost-effectiveness analyses of potential life-saving interventions might be worthwhile or which proposed life-saving interventions are very unlikely to benefit from such additional research.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington New Zealand.

ABSTRACT

Objective: We aimed to estimate the maximum intervention cost (EMIC) a society could invest in a life-saving intervention at different ages while remaining cost-effective according to a user-specified cost-effectiveness threshold.

Methods: New Zealand (NZ) was used as a case study, and a health system perspective was taken. Data from NZ life tables and morbidity data from a burden of disease study were used to estimate health-adjusted life-years (HALYs) gained by a life-saving intervention. Health system costs were estimated from a national database of all publicly funded health events (hospitalizations, outpatient events, pharmaceuticals, etc.). For illustrative purposes we followed the WHO-CHOICE approach and used a cost-effectiveness threshold of the gross domestic product (GDP) per capita (NZ$45,000 or US$30,000 per HALY). We then calculated EMICs for an "ideal" life-saving intervention that fully returned survivors to the same average morbidity, mortality, and cost trajectories as the rest of their cohort.

Findings: The EMIC of the "ideal" life-saving intervention varied markedly by age: NZ$1.3 million (US$880,000) for an intervention to save the life of a child, NZ$0.8 million (US$540,000) for a 50-year-old, and NZ$0.235 million (US$158,000) for an 80-year-old. These results were predictably very sensitive to the choice of discount rate and to the selected cost-effectiveness threshold. Using WHO data, we produced an online calculator to allow the performance of similar calculations for all other countries.

Conclusions: We present an approach to estimating maximal cost-effective investment in life-saving health interventions, under various assumptions. Our online calculator allows this approach to be applied in other countries. Policymakers could use these estimates as a rapid screening tool to determine if more detailed cost-effectiveness analyses of potential life-saving interventions might be worthwhile or which proposed life-saving interventions are very unlikely to benefit from such additional research.

No MeSH data available.