Equitable Prioritization of Health Interventions by Incorporating Financial Risk Protection Weights Into Economic Evaluations [Editor's Choice]

Mar 1, 2023, 00:00
10.1016/j.jval.2022.09.007
https://www.valueinhealthjournal.com/article/S1098-3015(22)02186-6/fulltext
Title : Equitable Prioritization of Health Interventions by Incorporating Financial Risk Protection Weights Into Economic Evaluations [Editor's Choice]
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(22)02186-6&doi=10.1016/j.jval.2022.09.007
First page : 411
Section Title : METHODOLOGY
Open access? : No
Section Order : 411

Objectives

Financial risk protection (FRP), or the prevention of medical impoverishment, is a major objective of health systems, particularly in low- and middle-income countries where the extent of out-of-pocket (OOP) health expenditures can be substantial. We sought to develop a method that allows decision makers to explicitly integrate FRP outcomes into their priority-setting activities.

Methods

We used literature review to identify 31 interventions in low- and middle-income countries, each of which provided measures of health outcomes, costs, OOP health expenditures averted, and FRP (proxied by OOP health expenditures averted as a percentage of income), all disaggregated by income quintile. We developed weights drawn from the Z-score of each quintile-intervention pair based on the distribution of FRP of all quintile-intervention pairs. We next ranked the interventions by unweighted and weighted health outcomes for each income quintile. We also evaluated how pro-poor they were by, first, ordering the interventions by cost-effectiveness for each quintile and, next, calculating the proportion of interventions each income quintile would be targeted for a given random budget. A ranking was said to be pro-poor if each quintile received the same or higher proportion of interventions than richer quintiles.

Results

Using FRP weights produced a more pro-poor priority setting than unweighted outcomes. Most of the reordering produced by the inclusion of FRP weights occurred in interventions of moderate cost-effectiveness, suggesting that these weights would be most useful as a way of distinguishing moderately cost-effective interventions with relatively high potential FRP.

Conclusions

This preliminary method of integrating FRP into priority-setting would likely be most suitable to deciding between health interventions with intermediate cost-effectiveness.

Categories :
  • Confounding, Selection Bias Correction, Causal Inference
  • Health Disparities & Equity
  • Health Policy & Regulatory
  • Literature Review & Synthesis
  • Methodological & Statistical Research
  • Study Approaches
Tags :
  • economic evaluation
  • equity
  • financial risk protection
  • low- and middle-income countries
  • priority setting
Regions :
  • Global
ViH Article Tags :