12:30—2:00 PM
Center for Global Development
2055 L Street NW
- Fifth Floor
Washington, DC 20036

Thresholds for the Cost–Effectiveness of Interventions: Alternative Approaches

A Brownbag Seminar


Elliot Marseille
Health Strategies International

James G. Kahn
University of California, San Francisco


Mead Over
Senior Fellow
Center for Global Development

Determining which health interventions represent good value for money and are therefore good investments is an ongoing challenge for policymakers. A common approach to making these decisions has involved the use of thresholds based on per capita GDP. Specifically, many countries follow the World Health Organization’s Choosing Interventions that are Cost-Effective (WHO-CHOICE) project’s recommendation: an intervention that, per disability-adjusted life year (DALY) averted, costs less than three times the national annual GDP per capita is considered cost-effective.

Elliot Marseille and James Kahn, however, say this approach has major shortcomings. During this session, they made the case that the WHO-CHOICE thresholds are not useful for most decision-making in public health because they set the bar for cost-effectiveness too low, omit any consideration of what is truly affordable, and skirt the difficult but necessary ranking of the relative values of locally-applicable interventions. Marseille and Kahn offered alternative approaches for applying cost-effectiveness criteria to choices in the allocation of health-care resources.

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