Generalised Cost-Effectiveness Analysis of 159 Health Interventions For The Ethiopian Essential Health Service Package [post]

Getachew Teshome, Alemayehu Hailu, Karin Stenberg, Kjell Arne Johansson, Ole Frithjof Norheim, Melanie Y Bertram
2020 unpublished
Background: Cost effectiveness was a criterion used to revise Ethiopia's essential health service package (EHSP) in 2019. However, there are few cost-effectiveness studies from Ethiopia or directly transferable evidence from other low-income countries to inform a comprehensive revision of the Ethiopian EHSP. Therefore, this paper reports average cost-effectiveness ratios (ACERs) of 159 health interventions used in the revision of Ethiopia's EHSP. Methods: In this study, we estimate ACERs for 77
more » ... timate ACERs for 77 interventions on reproductive maternal neonatal and child health (RMNCH), infectious diseases and water sanitation and hygiene as well as for 82 interventions on non-communicable diseases. We used the standardised World Health Organization CHOosing Interventions that are Cost Effective methodology for generalised cost-effectiveness analysis. The health benefits of interventions were determined using a population state-transition model, which simulates the Ethiopian population, accounting for births, deaths and disease epidemiology. Healthy life years (HLYs) gained was employed as a measure of health benefits, and we estimated the economic costs of interventions from the health system perspective, including programme overhead and training costs. We used the Spectrum generalised cost-effectiveness analysis tool for data analysis. We did not explicitly apply cost-effectiveness thresholds, but we used US$100 and $1,000 as references to summarise and present the ACER results. Results: We found ACERs ranging from less than US$1 per HLY gained (for family planning) to about US$48,000 per HLY gained (for treatment of stage 4 colorectal cancer). In general, 75% of the interventions evaluated had ACERs of less than US$1,000 per HLY gained. The vast majority (95%) of RMNCH and infectious disease interventions had an ACER of less than US$1,000 per HLY while almost half (44%) of non-communicable disease interventions had an ACER greater than US$1,000 per HLY. Conclusion: The present study shows that several potential cost-effective interventions are available that could substantially reduce Ethiopia's disease burden if scaled up. The use of the World Health Organization's generalised cost-effectiveness analysis tool allowed us to rapidly calculate country-specific cost-effectiveness analysis values for 159 health interventions under consideration for Ethiopia's EHSP.
doi:10.21203/ fatcat:5dtiy5pllrf5zm6sodytetqcju