Presentation (CTI)

OBJECTIVES: To build and apply PAVE-MA (Prevention, Area-by-area Value Evaluation, Morocco), a standardized way to value prevention from a public payer perspective, separating prevention that pays for itself from prevention worth funding despite not saving money.
METHODS: The inputs were standardized, not the model. All areas used the same rules: Moroccan data first, then MENA, then international; each figure graded for evidence quality; a public payer perspective; Moroccan dirham; 3% discounting; CHEERS 2022 reporting. Costs used official Moroccan sources (drug prices, tariffs, payer data). The model fit each disease, cohort cost-offset, threshold analysis, or natural-unit valuation, using trial effect sizes. Nine areas were scoped, five modeled, the rest illustrative.
RESULTS: Verdicts varied by area, requiring different designs. In chronic kidney disease, early nephroprotection (cohort cost-offset) was cost-effective and became cost-saving beyond a 4.4-year dialysis-delay threshold (number needed to treat 71 per dialysis averted). In hypertension, the same cost-offset design was cost-effective but not cost-saving, at approximately 76,000 MAD per stroke averted. In COPD (threshold analysis), triple-therapy escalation self-financed only above 1.5 to 2.0 severe exacerbations per year. In osteoporosis (natural-unit valuation, number needed to treat too high for any offset), treatment was not cost-saving, with cost per hip fracture averted 26 to 145 times the acute cost; value derived from a 28% all-cause mortality reduction. In HPV (disease-cost-averted), vaccination averted approximately 730 deaths and 66 million MAD in annual care costs at high coverage.
CONCLUSIONS: Prevention's economic role differs by disease, so no single metric applies, and one design yielded opposite verdicts. A standardized, tiered, locally sourced protocol makes this explicit, separating self-financing prevention from high-value health purchases and supporting traceable payer financing. PAVE-MA provides a common evaluative scaffold, not pooled estimates; several areas remain illustrative pending local data.