Cost effectiveness and strategic planning (WHO-CHOICE)

An overview of the rationale, activities and goals of WHO-CHOICE

Can analysts adapt the estimates to their own settings?

WHO-CHOICE regional databases represent a compromise between the derivation of a single global estimate of the cost-effectiveness of an intervention (which, by definition, is unlikely to appropriately reflect costs and effects in a large number of countries), versus the generation of estimates for each and every member state. Even so, the existence of cost-effectiveness information at the aggregate level of WHO regions is no guarantee that findings and recommendations will actually change health policy or practice at the national level (where policies are determined and resources actually allocated).

Accordingly, WHO-CHOICE advocates the use of a process of contextualisation, whereby available regional estimates can be tailored to the particular demographic, epidemiological and economic situation facing a given country. Most crudely, this can be achieved by simply mapping regional epidemiolgical estimates to the population in question and expressing costs in local currency units; such an approach, however, still runs the risk of missing important differences between a country and the region to which it belongs concerning key parameters such as disease incidence and prevalence, intervention coverage and effectiveness, or rates of service utilisation. A preferred approach, therefore, is a more systematic process of contextualisation, involving the inspection and revision of all model parameters in the context of a specific country.

Condition-specific templates for full contextualisation are now available for a number of diseases and risk factors (including interventions for TB and malaria, tobacco and alcohol control, schizophrenia and depression), and have been applied to the national context of a number of developed and developing countries.

For an overview of analytical tools used to generate information on costs and effectiveness, please see the WHO-CHOICE Tool kit

For other information, please contact the WHO-CHOICE team