ICER threshold

Asked: 25 Dec 2023 | 96

I am doing my master thesis on the model-based cost-effectiveness of cardiovascular risk screening program in Zambia. P: population in Zambia age 40 - 79 years old I: non-laboratory-based WHO CVD risk chart and laboratory-based WHO CVD risk chart C: no screening, comparison between non-laboratory-based and non-laboratory-based screening O: DALYs (literature reviews and data from GBOD) I am searching the Zambia's ICER threshold from the literature and so far seen none. I think the WHO thereshold which refers to 1 or 3% of GDP per capita might not represent the country's budget. Do you have any suggestion which threshold reference I can use?

Costing Modelling

Expert Replies:

Hugo Turner

Lecturer | United Kingdom | Replied: 10 Jan 2024 at 17:26

Many thanks for your question.

In the past, when no country-specific threshold has been set many used the cost-effectiveness thresholds set by the Commission on Macroeconomics and Health; namely a cost per DALY averted <3 and <1 times the country's gross domestic product (GDP) per capita for a intervention being cost-effective and highly cost-effective, respectively. Note that these are used to compare to the cost per DALY averted value and not expressed as a %. However, these are now considered to be too high and have become widely criticised. The WHO has outlined that these thresholds were not intended for individual investment decisions but as a broad principle for global/regional level analyses.

I would recommend looking at this paper: The Use of Cost-Effectiveness Thresholds for Evaluating Health Interventions in Low- and Middle-Income Countries From 2015 to 2020: A Review – for more background on this topic.

In terms of solutions, I would either:
• Adjusting the country threshold value from the following study for inflation. Woods B, Revill P, Sculpher M, Claxton K. Country-Level Cost-Effectiveness Thresholds: Initial Estimates and the Need for Further Research. Value Health. 2016 Dec;19(8):929-935. doi: 10.1016/j.jval.2016.02.017.
• Use 0.5 times the per capita GDP.