ABSTRACT

Background

Current health economic analysis guidelines emphasize the importance of using nationally appropriate cost and valuation inputs. However, some countries lack national data, and some analyses focus on interventions with costs and benefits at regional or global scales.

Methods

Recognizing the need for better estimates of appropriate values for application at these levels than those used in the past, we characterize population-weighted dollar per disability-adjusted life year (DALY) averted by World Bank Income Level based on available national estimates of the marginal productivity of the healthcare system.

Results

The defaults suggested here reflect health opportunity costs across countries more consistent with existing evidence than those previously used or recommended. As countries change income levels and healthcare spending, and as additional or updated marginal productivity of healthcare expenditure estimates become available, we expect the defaults to change.

Conclusion

The best option for informing decisions around resource allocation in health care such that they improve health outcomes overall remains the use of time-appropriate country-specific estimates of the marginal productivity of the healthcare system. Instead of single, time-invariant defaults, health economists should seek to develop valuation inputs that better account for health opportunity costs and do so over time.

中文翻译：

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重视健康结果：根据健康机会成本制定更好的默认值

摘要

背景

当前的卫生经济分析指南强调使用适合国家的成本和估值输入的重要性。然而，一些国家缺乏国家数据，一些分析侧重于在区域或全球范围内具有成本和效益的干预措施。

方法

认识到与过去使用的相比，需要更好地估计在这些水平上应用的适当值，我们根据可用的国家边际估计值来描述世界银行收入水平所避免的每个残疾调整生命年 (DALY) 的人口加权美元医疗保健系统的生产力。

结果

此处建议的默认值反映了各国的卫生机会成本，与现有证据相比，以前使用或推荐的更符合现有证据。随着各国收入水平和医疗支出的变化，以及医疗支出边际生产力估计值的增加或更新，我们预计默认值会发生变化。

结论

为围绕医疗保健资源分配的决策提供信息以改善整体健康结果的最佳选择仍然是使用适合时间的特定国家/地区对医疗保健系统边际生产力的估计。与单一的、不随时间变化的违约不同，健康经济学家应该寻求开发能够更好地考虑健康机会成本的估值输入，并随着时间的推移这样做。