ESTIMATING THE HEALTH OPPORTUNITY COST OF PUBLIC HEALTH EXPENDITURE IN KAZAKHSTAN: EMPIRICAL SUPPLY-SIDE COST-EFFECTIVENESS THRESHOLDS
Author(s)
Alexandr Kostyuk, PhD, MD1, Jeffrey Hoch, PhD2, Alima Almadiyeva, MScPH, MD3, Aidar Abeuov, MScPH3;
1University of California, Davis, Department of Public Health Sciences, Davis, CA, USA, 2University of California, Davis, Division of Health Policy and Management, Department of Public Health Sciences, Davis, CA, USA, 3Kazakh Agency for Health Technology Assessment, Astana, Kazakhstan
1University of California, Davis, Department of Public Health Sciences, Davis, CA, USA, 2University of California, Davis, Division of Health Policy and Management, Department of Public Health Sciences, Davis, CA, USA, 3Kazakh Agency for Health Technology Assessment, Astana, Kazakhstan
OBJECTIVES: This study estimates a supply-side cost-effectiveness threshold for Kazakhstan by examining health forgone when public resources are redirected to new health technologies. Rather than relying on international reference values, the analysis focuses on the realities of a fiscally constrained health system and derives a shadow price of health based on observed performance within the country.
METHODS: We analysed panel data for all regions of Kazakhstan, 2020-2024, linking regional public health expenditure to age-standardised mortality. An instrumental variable fixed-effects approach was used to address endogeneity between spending and outcomes. Estimated mortality effects were translated into years of life lost averted and then extended to disability-adjusted and quality-adjusted life years using established burden-of-disease ratios and age-specific utility weights.
RESULTS: IIncreased public health spending is associated with positive but modest marginal health gains, suggesting that the system operates close to its resource limits. The estimated marginal cost per DALY averted corresponds to 0.52 to 0.68 times GDP per capita accounting for non-fatal losses. The implied cost per QALY gained ranges from 58% to 75% of GDP per capita. Using a 2024 GDP per capita of USD 14,445, this results in a supply-side threshold range of USD 8,378 to 10,833 per QALY. Estimates expressed in DALYs are consistently higher than those based on QALYs, reflecting the significant role of morbidity in Kazakhstan’s disease burden and highlighting the risk of undervaluing interventions that primarily improve quality of life rather than survival.
CONCLUSIONS: A base threshold set at 0.75 times GDP per capita provides a realistic representation of the health opportunity cost faced by Kazakhstan’s health system. To account for fairness concerns, we recommend applying equity multipliers, allowing the base value to be multiplied by two for severe conditions with substantial quality-of-life loss and by three for rare diseases characterised by high costs and limited treatment options.
METHODS: We analysed panel data for all regions of Kazakhstan, 2020-2024, linking regional public health expenditure to age-standardised mortality. An instrumental variable fixed-effects approach was used to address endogeneity between spending and outcomes. Estimated mortality effects were translated into years of life lost averted and then extended to disability-adjusted and quality-adjusted life years using established burden-of-disease ratios and age-specific utility weights.
RESULTS: IIncreased public health spending is associated with positive but modest marginal health gains, suggesting that the system operates close to its resource limits. The estimated marginal cost per DALY averted corresponds to 0.52 to 0.68 times GDP per capita accounting for non-fatal losses. The implied cost per QALY gained ranges from 58% to 75% of GDP per capita. Using a 2024 GDP per capita of USD 14,445, this results in a supply-side threshold range of USD 8,378 to 10,833 per QALY. Estimates expressed in DALYs are consistently higher than those based on QALYs, reflecting the significant role of morbidity in Kazakhstan’s disease burden and highlighting the risk of undervaluing interventions that primarily improve quality of life rather than survival.
CONCLUSIONS: A base threshold set at 0.75 times GDP per capita provides a realistic representation of the health opportunity cost faced by Kazakhstan’s health system. To account for fairness concerns, we recommend applying equity multipliers, allowing the base value to be multiplied by two for severe conditions with substantial quality-of-life loss and by three for rare diseases characterised by high costs and limited treatment options.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE410
Topic
Economic Evaluation
Topic Subcategory
Thresholds & Opportunity Cost
Disease
No Additional Disease & Conditions/Specialized Treatment Areas