Bryan N Patenaude1, Innocent Semali2, Japhet Killewo2, Till Bärnighausen3. 1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: bnp706@mail.harvard.edu. 2. Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. 3. Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Africa Health Research Institute, Somkhele and Durban, South Africa.
Abstract
BACKGROUND: The value of a statistical life-year (VSLY) is the central number for the economic allocation of health resources. Nevertheless, empirical data on VSLY are lacking for most low- and middle- income countries. In the absence of empirically established VSLY, researchers typically use an arbitrary 3-times multiple of per-capita gross domestic product or per-capita income per life-year saved to establish cost-effectiveness. OBJECTIVE: In this study, we establish an empirical VSLY for the first time for a community in sub-Saharan Africa. METHODS: To empirically establish VSLY, we randomly selected 4000 individuals in the Ukonga community of Tanzania and employed a contingent valuation survey to measure VSLY. Using the contingent valuation methodology, we elicited willingness to pay for a 2% mortality risk reduction and had individuals convert this into an annualized payment to be paid each year over their expected remaining life. RESULTS: We compared our elicited value to per-capita income and found that mean VSLY is $9340 (95% CI $6206-$12 373). The mean annual income in our sample was $2069, resulting in a VSLY that is equivalent to 4.5 times per-capita income. CONCLUSION: Our results provide empirical evidence to support moving away from using the World Health Organization cost-effectiveness thresholds in practice because they will likely result in inefficient underinvestment in cost-effective interventions, even in relatively poor samples.
BACKGROUND: The value of a statistical life-year (VSLY) is the central number for the economic allocation of health resources. Nevertheless, empirical data on VSLY are lacking for most low- and middle- income countries. In the absence of empirically established VSLY, researchers typically use an arbitrary 3-times multiple of per-capita gross domestic product or per-capita income per life-year saved to establish cost-effectiveness. OBJECTIVE: In this study, we establish an empirical VSLY for the first time for a community in sub-Saharan Africa. METHODS: To empirically establish VSLY, we randomly selected 4000 individuals in the Ukonga community of Tanzania and employed a contingent valuation survey to measure VSLY. Using the contingent valuation methodology, we elicited willingness to pay for a 2% mortality risk reduction and had individuals convert this into an annualized payment to be paid each year over their expected remaining life. RESULTS: We compared our elicited value to per-capita income and found that mean VSLY is $9340 (95% CI $6206-$12 373). The mean annual income in our sample was $2069, resulting in a VSLY that is equivalent to 4.5 times per-capita income. CONCLUSION: Our results provide empirical evidence to support moving away from using the World Health Organization cost-effectiveness thresholds in practice because they will likely result in inefficient underinvestment in cost-effective interventions, even in relatively poor samples.
Authors: Olivia Ferguson; Youngji Jo; Jeff Pennington; Karl Johnson; Richard E Chaisson; Gavin Churchyard; David Dowdy Journal: J Int AIDS Soc Date: 2020-10 Impact factor: 5.396
Authors: Stefan T Trautmann; Yilong Xu; Christian König-Kersting; Bryan N Patenaude; Guy Harling; Ali Sié; Till Bärnighausen Journal: Popul Health Metr Date: 2021-11-17