VARIATION IN AVERAGE INCREMENTAL COST-EFFECTIVENESS RATIOS ACROSS DISEASE GROUPS AND THE DISTRIBUTION OF RESEARCH AND DEVELOPMENT FUNDS
Author(s)
Abdülkadir Civan, PhD1, Claudia Denkinger, MD2;
1Heidelberg University, Heidelberg, Germany, 2Heidelberg University Medical Faculty, Heidelberg, Germany
1Heidelberg University, Heidelberg, Germany, 2Heidelberg University Medical Faculty, Heidelberg, Germany
OBJECTIVES: Global health R&D funding per disability-adjusted life year (DALY) varies substantially across disease areas. However, funding heterogeneity alone does not prove inefficiency. This study introduces the “Category ICER”—the average cost-effectiveness of interventions within a disease group—as a novel metric for R&D productivity. We developed a normative model suggesting that efficient R&D allocation implies greater research intensity in disease groups, yielding lower Category ICERs
METHODS: We constructed a theoretical framework for optimal global health R&D allocation in which investment is prioritized based on the marginal cost of health gains. We empirically assessed the model’s implications by analyzing 1,558 ICER estimates from the Global Health Cost-Effectiveness Analysis Registry across 14 infectious disease groups. ICERs were normalized by country-specific health system productivity and aggregated into Category ICERs. These were then compared with G20 R&D funding per DALY (2000-2017) to evaluate alignment with the normative benchmark.
RESULTS: The model implies that efficient allocation is associated with higher research intensity in fields with lower Category ICERs. Empirically, while R&D funding per DALY varies substantially, Category ICERs exhibit even greater heterogeneity, with a 140-fold difference across disease groups. Contrary to model implications, we observed a weak positive correlation (r = 0.23) between funding intensity and Category ICERs, suggesting a limited alignment between funding patterns and health-value productivity.
CONCLUSIONS: Observed global health R&D investment patterns appear inconsistent with conditions for efficient health-value generation. By showing weak alignment between funding intensity and average cost-effectiveness, this study highlights potential inefficiencies in global resource allocation. The Category ICER provides a transparent, outcome-based metric that may help inform R&D priority setting toward areas with the highest potential for cost-effective impact.
METHODS: We constructed a theoretical framework for optimal global health R&D allocation in which investment is prioritized based on the marginal cost of health gains. We empirically assessed the model’s implications by analyzing 1,558 ICER estimates from the Global Health Cost-Effectiveness Analysis Registry across 14 infectious disease groups. ICERs were normalized by country-specific health system productivity and aggregated into Category ICERs. These were then compared with G20 R&D funding per DALY (2000-2017) to evaluate alignment with the normative benchmark.
RESULTS: The model implies that efficient allocation is associated with higher research intensity in fields with lower Category ICERs. Empirically, while R&D funding per DALY varies substantially, Category ICERs exhibit even greater heterogeneity, with a 140-fold difference across disease groups. Contrary to model implications, we observed a weak positive correlation (r = 0.23) between funding intensity and Category ICERs, suggesting a limited alignment between funding patterns and health-value productivity.
CONCLUSIONS: Observed global health R&D investment patterns appear inconsistent with conditions for efficient health-value generation. By showing weak alignment between funding intensity and average cost-effectiveness, this study highlights potential inefficiencies in global resource allocation. The Category ICER provides a transparent, outcome-based metric that may help inform R&D priority setting toward areas with the highest potential for cost-effective impact.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR108
Topic
Health Policy & Regulatory
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Infectious Disease (non-vaccine)