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dc.contributor.authorJohansson, Kjell Arneen_US
dc.contributor.authorTolla, Mieraf Taddesseen_US
dc.contributor.authorMemirie, Solomon Tessemaen_US
dc.contributor.authorMiljeteig, Ingriden_US
dc.contributor.authorHabtemariam, Mahleten_US
dc.contributor.authorWoldemariam, Addis Tamireen_US
dc.contributor.authorVerguet, Stéphaneen_US
dc.contributor.authorNorheim, Ole Frithjofen_US
dc.PublishedJohansson KA, Tolla MT, Memirie ST, Miljeteig I, Habtemariam, Woldemariam, Verguet S, Norheim OF. Country contextualisation of cost-effectiveness studies: lessons from Ethiopia. BMJ Global Health. 2019;4:e001320eng
dc.description.abstractEmerging demographic, epidemiological and health system changes in low-income countries require revisions of national essential health services packages in accordance with standard healthcare priority setting methods. Policy makers are in need of explicit and user-friendly methods to compare impact of multiple interventions. We provide experiences of country contextualisation of WHO-CHOICE methods and models to a country level. Results from three contextualised cost-effectiveness analyses (CEAs) are presented, and we discuss how this evidence can inform priority setting in Ethiopia. Existing models for a range of interventions in obstetric and neonatal care, psychiatric and neurological treatment and prevention and treatment of cardiovascular diseases are contextualised to the Ethiopian setting. CEAs are defined as contextualised if they include national analysts and use country-specific input for either costs, epidemiology, demography, baseline coverage or effects. Interventions (n=61) are ranked according to incremental cost-effectiveness rates (ICERs), and expected health outcomes (Disability Adjusted Life Years (DALYs) averted) and budget impacts are presented for each intervention. Dominated interventions (n=30) were excluded. A USD2.8 increase per capita in the annual health budget is needed in Ethiopia (currently at USD28 per capita) for increasing coverage by 20%–75% for all the 22 interventions with positive net health benefits. This investment is expected to give a net benefit at around 0.5 million DALYs averted in return in total, with a willingness to pay threshold at USD2000 per DALY averted. In particular, three interventions, neonatal resuscitation, kangaroo mother care and antibiotics for newborn sepsis, stand out as best buys in an Ethiopian setting. Our method of contextualised CEAs provides important information for policy makers. Rank ordering of interventions by ICERs, together with presentations of expected budget impact and net health benefits, is a clear and policy friendly illustration of possible efficient stepwise pathways towards universal health coverage.en_US
dc.rightsAttribution CC BYeng
dc.titleCountry contextualisation of cost-effectiveness studies: lessons from Ethiopiaen_US
dc.typePeer reviewed
dc.typeJournal article
dc.rights.holderCopyright 2019 The Author(s)
dc.source.journalBMJ Global Health

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