Use Of Economic Evaluation In Low- And Middle- Income Countries Like Nepal

With the availability of futuristic technologies, we have come across numerous opportunities by which health can be improved. Any intervention, be it large or small scale, involves cost to the health system and to the patients. However, the resources available are scarce especially in low- and middle- income countries like Nepal.There is always a limit to the budget and resources available to the government, health care providers and the citizens. So, we have to make a difficult choice on which intervention should we spend our resources on to receive maximum benefits in return. This is where economic evaluation comes into play, it can help set out the value of costs and benefits between competing alternatives available. Use of economic evaluation to implement cost-effective interventions will allow LMICs to make the optimum use of scarce resources to improve the health status of the population.

Different methods of economic evaluation are used depending on the target population, size of the institution and level of governance. A hospital can use Clinical Decision Analysis (CDA), to identify the most effective treatment method for any specific disease. Likewise, on a larger scale, health systems of different countries can use Cost-effectiveness (CE) threshold. CE threshold is defined as a change in cost divided by change in health outcomes (disease or death averted or life years gained). It is described as the maximum amount a decision maker is willing to pay for a unit of health outcome. National Institute of Health and Clinical Excellence (NICE), UK has the CE threshold of GBP 20,000 per life years gained. Likewise, in the United States, interventions ranging from USD 10,000 – USD 50,000 per life years are classified as cost-effective and interventions with ratio equal to or greater than USD 10,000 as classified as highly cost-effective.