Global health policy - two new CHE research papers

WHO decides what is fair? International HIV treatment guidelines, social value judgements and equitable provision of lifesaving antiretroviral therapy

(Paul Revill, Miqdad Asaria, Andrew Phillips, Diana M Gibb, Charles F Gilks) 

International guidelines often make aspirational recommendations for health policy in low and middle income countries. Direct interpretation of such guidelines typically implies a "human rights" based approach in seeking to provide individual patients with the best alternatives amongst those available on the basis of current evidence. However, there lies a basic conflict between this and "consequentialist" public health based approaches that provide more equal population-level outcomes. When interpreting international guidelines and attempting to fairly allocate scarce lifesaving resources, national policymakers must carefully consider the distribution of outcomes and the underpinning social value judgements required to inform policy choice. It is important to consider whose values should determine what is a just distribution of health outcomes. International organisations' guidelines committees may be well placed to compile evidence on the costs and effects of health care alternatives, however, their mandate for making distributional social value judgements remains unclear. In this research paper we explore these ideas in the context of the 2013 WHO Consolidated Guidelines on the Use of Antiretroviral Therapy (ART). CHE Research Paper 99 (PDF , 694kb)

Using cost-effectiveness thresholds to determine value for money in low-and middle-income country healthcare systems: Are current international norms fit for purpose?

(Paul Revill, Simon Walker, Jason Madan, Andrea Ciaranello, Takondwa Mwase, Diana M Gibb, Karl Claxton, Mark J Sculpher)

Frequently adopted cost-effectiveness thresholds, particularly those recommended by the WHO, fail to acknowledge that programmes and interventions are only cost-effective if their health benefit exceeds that which will be lost because the resources required will not be available to implement other effective interventions. Consequently current judgements about which interventions and programmes are cost-effective do not reflect the reality of resource constraints and their use is likely to reduce overall population health and exacerbate healthcare inequalities.  Thresholds based upon assessments of how else resources can be used hold promise of generating greater population health gains from the means available.  The bases for making value for money assessments are also explored in the context of the 2013 WHO Consolidated Guidelines on the Use of Antiretroviral Therapy (ART) and decisions relating to how patients on ART are monitored. CHE Research Paper 98 (PDF , 592kb)

 Other papers in this series can be found at: CHE Research Papers