Table 3 Sources of input parameters and results
Author (references) | Source of cost data | Source of epidemiological data | Source of effectiveness data | Source of utility data | Source of funding | Threshold | ICER and results | Conclusion |
|---|---|---|---|---|---|---|---|---|
Adibi et al. [21] | Iranian | Iranian, international and expert consensus | International | NA | Academia | 1 GDP (US$ 1790 in 2003) | The cost/CHB infection averted was US$ 202 and 197 for the strategies 1 and 2, respectively | Premarriage prevention of HBV transmission in Iran seems cost saving |
Al Abri et al. [22] | Omani and international | Omani and international | International | International | Industry | WTP of US$ 100,000 in 2020 | The QFT-Plus with 3HP was more cost-effective than the other TB strategies with an ICER of US$ 2915/QALY gained. The CXR strategy was the least cost-effective | IGRA testing followed by 3HP is the most cost-effective intervention |
Al‐Qudah et al. [23] | Jordanian and assumption | Jordanian | International | NA | None | NA | Benefit‐to‐cost ratio was 5.98 and an annual net benefit was US$ 64,393 | Clinical pharmacist intervention is cost beneficial and offers substantial cost savings to the healthcare payer |
Assanelli et al. [24] | Algerian | International | International | NA | Industry | NR | The total cost in Algeria was $PPP 79,395, total cost/athlete was $PPP 74.10, and CER of screening was $PPP 582 | Results strongly support the utilization of 12-lead ECG in the pre participation screening of young athletes |
Balicer et al. [25] | Local | International | International | NA | NR | NA | Therapeutic treatment and postexposure prophylaxis were shown to be cost-saving, with a cost–benefit ratio of 2.44–3.68 | Pre pandemic stockpiling of Oseltamivir is cost-saving to the economy and to the healthcare system, if the use is limited to treat patients at high risk |
Barfar et al. [26] | Iranian | Iranian | International | NA | Government | NR | ICER/breast cancer detected was US$ 15,742 | Mammography screening program is not cost-effective |
Carvalho et al. [27] | WHO CHOICE, donors and local | Afghan and international | NR | NA | NGO | 1–3 GDP/C (US$ 500–1500 in 2009/10) | ICERs of family planning strategies were below US$ 130/LYG. ICERs of stepwise improvements in maternal health services were below US$ 200/LYG | The combination of investment in reproductive health infrastructure and increase in family planning is highly cost-effective |
Chodick et al. [28] | Local and international | Local | International | NA | NR | NR | The incremental cost of screening and vaccination of susceptible workers was US$ 23,713/avoided case, serological tests was US$ 206,692/avoided case, and vaccinating all HCWs without serotesting wad US$ 10.4 million/avoided case | Screening and vaccination of susceptible workers using anamnestic selection are cost-effective while screening alone and mass vaccination alone of all HCWs without serotesting are not cost-effective |
Chodick et al. [29] | Local and international | Local and international | International | International | Government | US$ 60,000 | Screening prior vaccination among 18- to 39-year-old physicians and paramedical workers achieved the lowest cost per prevented Hepatitis A case (US$ 6240 and 6773, respectively). ICERs/QALY were US$ 56,532 and 61,350 for the same groups | Screening followed by selective vaccination for physicians and for paramedical workers is recommended |
Chowers [30] | Local | Local and international | International | Local and international | NR | 1–3 GDP/C (US$ 28,667–86,000) in 2014) | Universal prenatal screening dominates over the current policy with an ICER of (US$ -11,546)/QALY gained | Universal prenatal HIV screening is projected to be cost saving |
Devine [31) | International | International | International | International | Government, academia and NGO | 1 GDP/C | The ICERs were US$ 18.6 for 14-day Primaquine (without G6PD screening), US$ 1089 for Tafenoquine in male and 7-day Primaquine in female (both with G6PD screening) | Using a gender-based treatment strategy could significantly change the landscape for providing the radical cure of Plasmodium vivax Malaria |
El-Dahiyat [32] | Jordanian | NA | NA | NA | None | NA | The average savings if using the generic drugs instead of the originator brand medicines in Jordan was 32.68%, and the maximum savings was 74.29% | Generic substitution can provide significant savings to patients and healthcare system |
El-Ghitany [33] | Egyptian | Egyptian | NR | NA | None | NR | Using EGCRISC would save LE 0.43 billion accounting for about 21,646,227 unnecessary tests | EGCRISC is a cost-effective tool that must be adopted nationwide |
Eltabbakh et al. [34] | Egyptian | NR | NR | International | NR | 1–3 GDP/C (US$ 3184–9553) | ICER was not reported. The costs were US$ 1105 and 1180/QALY for screening with ultrasound only and for both ultrasound and alpha-fetoprotein, respectively | Screening for HCC is highly cost-effective |
Gamaoun et al. [35] | Tunisian, international and estimations | Tunisian and international | Tunisian and international | NA | NR | NR | The incremental cost of cervical cancer screening according to 10-year periodicity was US$ 8219, 5-year periodicity was US$ 14,567, 3-year periodicity was US$ 20,479, and finally the national vaccination program was US$ 36,854 per avoided cervical cancer case | Cervical cancer screening each 5 years combined with scheduled two-dose anti-HPV national vaccination program is the best cost-effective strategy for cervical cancer prevention |
Ginsberg et al. [36] | Local and assumptions | Local | Local and international | NA | NR | NA | The benefit–cost ratio of the program to the health services was 4.22:1 which increased to 6.01:1 when a societal perspective was taken | The monetary benefits of a nationwide thalassemia screening program to society and to the healthcare system exceeds the program's costs |
Ginsberg et al. [37] | Local | Local and international | International | International | NR | 1–3 GNP/C (US$ 27,055–81,165 in 2010) | ICER/DALY averted was US$ 2509 for Pap smear screening of females at age 40, US$ 10,543 for thrice a lifetime VIA, US$ 22,841 for three doses HPV vaccination at age 12 plus a booster dose at ages 32 and 52 combined with penta-annual Pap smear screening for females aged 20–65, and US$ 30,029 for addition of penta-annual HPV DNA screening to vaccination and penta-annual Pap smear | HPV screening interventions combined with vaccination program have the potential to be very cost-effective |
Ginsberg et al. [38] | Local | Local | International | International | None | 1–3 GDP/C (US$ 40,439–121,316 in 2017) | ICER of HIV pre-exposure prophylaxis drugs was around US$ 967,744/averted DALY | HIV pre-exposure prophylaxis drugs were found not to be cost-effective. Prices would have to fall by 90.7% for the intervention to become cost-effective |
Ginsberg et al. [39] | Local and international | Local | International | NR | NR | 1–3 GDP/C (US$ 20,366–61,098 in 2007) | ICER/QALY gained were US$ 65,024 for annual Pap smear, US$ 35,403 for tri-annual Pap smears, US$ 28,612 for penta-annual Pap smears, US$ 9,273 for thrice a lifetime Pap smears, US$ 48,660 for tri-annual Pap smears with HPV-DNA testing, US$ 33,705 for penta-annual combination, US$ 46,807 for a thrice a lifetime HPV-DNA testing, US$ 61,264 for thrice a lifetime VIA, US$ 81,404 for one-off HPV vaccination females aged 12, US$ 272,010 for vaccinating females every 10 years from age 12 to 62 | All HPV screening interventions are cost effective or highly cost-effective except for annual Pap smear and a thrice a lifetime VIA. HPV vaccination program is not cost-effective as well |
Ginsberg et al. [40] | Local and international | Local | NA | NR | NR | 1–3 GNP/C (NIS 104,161–312,483 in 2010) | Implementation of the cluster of interventions would save 32,671 QALYs at a cost of NIS 47,559/QALY | Fielding an eight-pronged combined clinical and community-based dietary interventional program is very cost-effective |
Haghighat et al. [41] | Iranian | Iranian and international | Iranian | International | None | 1–3 GDP/C (Int. $ 13,100–39,300 in 2012) | ICERs of mammography screening were Int. $ 37,350, Int. $ 141,641 and Int. $ 389,148/QALY gained in the first, second and third rounds of screening program, respectively | Mammography screening program is cost effective in 53% of the cases, but ICER/QALY in the second and third rounds of screening are not cost-effective |
Hamdani et al. [42] | Pakistani | Pakistani | Pakistani | NA | Government | US$ 67 | The mean ICER to successfully treat a case of depression using an international supervisor was US$ 517 compared with US$ 102.93 using a local one | The Problem Management + is more effective but also more costly |
Howard et al. [43] | Pakistani | Pakistani and international | NR | Afghan | None | 1–3 GDP/C (US$ 479–1436 in 2015) | The additional cost of including indoor residual spraying over five years per case prevented was US$ 39 (50 for Vivax and 182 for Falciparum). Per DALY averted this was US$ 266 | Adding indoor residual spraying is cost-effective |
Hussain et al. [44] | Pakistani | NR | International | International | NGO | NR | Incentive-based active case finding program costs US$ 223 per patient treated and incrementally averted 0.17 DALYs at the cost of US$ 15.74 over 6 months | Both screening strategies appear to be cost-effective in an urban Pakistani context |
Javadinasab et al. [45] | Iranian | Iranian and international | Iranian and international | International | NR | 1–3 GDP/C (US$ 5442–16,326 in 2014) | In CUA, compared with no screening, the ICERs/QALY gained were US$ 489 for one screening/lifetime at age 50, US$ 709 for one screening/lifetime at age 55, US$ 1010 for screening every 10 years starting at age 50, US$ 1386 for screening every 10 years starting at age 40, US$ 2310 for screening every 5 years starting at age 50 and US$ 3135 for screening every 5 years starting at the age of 40. In CEA, compared with no screening, the ICERs/LYG gained were US$ 725 for one screening/lifetime at age 50, US$ 1115 for one screening/lifetime at age 55, US$ 1540 for screening every 10 years starting at age 50, US$ 1995 for screening every 10 years starting at age 40, US$ 3508 for screening every 5 years starting at age 50, and US$ 4489 for screening every 5 years starting at the age of 40 | Colorectal cancer colonoscopy screening in high-risk individuals is cost-effective in Iran. Colonoscopy screening every 10 years starting at the age of 40 is the most cost-effective strategy |
Javanbakht [46] | Iranian | Iranian and international | NA | NA | Academia | NR | The estimated savings in health cost per capita were US$ 0.43, 8.42, 39.97 and 190.25 in 1, 5, 10 and 20-years’ time horizons, respectively. Corresponding total aggregated avoidable costs for entire population were US$ 33.83 million, 661.31 million, 3138.21 million and 14,934.63 million, respectively | Increasing dairy foods consumption to recommended levels would be associated with reductions in healthcare costs |
Kashi et al. [47] | Estimation | International | International | International | NGO | 1–3 GDP/C | The ICER of transitioning from iron and folic acid supplementation to multiple micronutrient supplementation was US$ 41.54/DALY in Pakistan | Multiple micronutrient supplementation is cost-effective and generates positive health outcomes for both infants and pregnant women |
Khneisser et al. [48] | Lebanese | Lebanese | NR | NA | Academia | NA | A reduction by half of direct cost of care, reaching on average US$ 31,631 per detected case was shown. This difference more than covers the expense of starting a newborn screening program | Direct and indirect costs saved through early detection of these disorders are important enough to justify universal publicly-funded screening, especially in developing countries with high consanguinity rates |
Khneisser et al. [49] | Lebanese | Lebanese | NR | NA | Academia | NA | The cost–benefit index of systematic screening was about 2.58 times lower than that of anemia-related hospitalizations in an unscreened population | The efficiency of routinely testing described in this study supports changes in screening policies for boys |
Kim et al. [50] | Egyptian | Egyptian and international | Egyptian and international | International | Academia | 1–3 GDP/C (US$ 3333–10,000 in 2014) | No screening would cost US$ 1840 for 19.179 QALYs. Implementing a screening program using triple-therapy was dominant compared to no screening because it would have lower total costs (US$ 1816) and lead to higher QALYs (19.229) | Screening and treatment programs for HCV in Egypt can be cost-effective methods to reduce the burden of liver disease |
Kim et al. [51] | Local, regional and assumption | Local and international | Local and international | International | NGO and public | 1 GDP/C (Int. $ 7521 in Algeria, 12,605 in Lebanon and 12,540 in Turkey; all in 2010 values) | Cytology-based screening alone was less cost effective, in Lebanon, Turkey and Algeria. The CER for combined vaccination and cytology screening was Int. $ 7520 in Algeria and 12,540 in Turkey while it was not cost-effective in Lebanon | Annual cytology screening is not cost-effective. Promoting organized, less frequent (3–5 years) screening and adopting HPV DNA testing can result in more efficient cervical cancer prevention efforts |
Koren et al. [52] | Local | Local | NR | NA | Industry | NR | The cost of preventing one affected newborn was US$ 63,660 compared to 1,971,380 for treatment of a patient during 50 years | Implementation of a national β Thalassemia prevention program appears cost-effective |
Lahiri et al. [53] | Local, regional and assumptions | International | International | NA | NGO | NR | In all of the sub-regions, training was the most cost-effective with CER of US$ 74 per LYG in the sub-region comprising of Egypt, Iraq, Morocco and Yemen so it would be the first choice option where resources are scarce | Worker training is a low cost and feasible first step toward reducing back pain/injury incidence. However, the engineering controls interventions as well as the full ergonomics program look very cost effective for all of the WHO sub-regions |
Leshno et al. [54] | Local | Local, international and estimations | International | NA | Industry | NR | Annual FOBT plus sigmoidoscopy during a 5-year interval was the best strategy with an ICER of NIS 1268/LYG | It is highly cost-effective to screen average-risk asymptomatic individuals beginning at age 50. One-time colonoscopic screening or FOBT plus sigmoidoscopy would be the preferred options |
Lim et al. [55] | Pakistani, international and assumption | Pakistani and international | NR | NA | NGO | NR | Screening and treatment strategy will cost US$ 3.9 billion over 13 years with the yearly costs making up 9% of the annual health budget of Pakistan. This translates to about US$ 600/cure | Pakistan needs to invest up to 9% of its yearly health expenditure (0.11% of its GDP, or approximately US$ 1.50 /person/year) to achieve the WHO HCV-elimination target |
Lohse et al. [56] | Local | International | International | NR | Industry | 1 GDP/C (US$ 29,500 in 2010) | The full costs of universal screening of pregnant women was US$ 5887/DALY | GDM screening and postpartum lifestyle management have an attractive cost-effectiveness ratio |
Madae’en et al. [57] | Jordanian | Jordanian | International | NA | None | 1–3 GDP/C (US$ 4395–13,185 in 2019) | 103,970 and 64,030 life years were gained using the Varenicline and NRT regimen compared to the no-intervention arm. The costs per LYG were US$ 1696 and US$ 1890 for Varenicline and NRT, respectively | Provision of Varenicline is a cost-effective intervention. Also, provision of NRT is likely to be cost-effective |
Marseille et al. [58] | Local, international and assumptions | Local, international and estimations | International | International | Industry | 1–3 GDP/C (US$ 29,800–89,400 in 2010) | The program cost/1000 pregnant women was US$ 259,929. The cost/DALY averted was US$ 1830 | By WHO standards, GDM interventions are highly cost-effective |
Mason et al. [59] | Local (from each country) | NR | International | NA | Academia and NGOs | NR | In all four countries most policies were cost saving compared with the baseline. The combination of all three policies resulted in estimated cost savings of US$ 235,000,000 and 6455 LYG in Tunisia; US$ 39,000,000 and 31,674 LYG in Syria; US$ 6,000,000 and 2682 LYG in Palestine and US$ 1,3000,000,000 and 378,439 LYG in Turkey | Reducing dietary salt intake will reduce CHD deaths in the four countries. Having a comprehensive health education strategy and food industry procedures for labeling and minimizing salt content would save money and lives |
Messoudi et al. [60] | Moroccan, regional and international | Moroccan | International | NA | Government, academia, NGO and industry | 1–3 GDP/C (US$ 2860–8580 in 2018) | The costs were US$ 551/LYS for current VIA screening and US$ 1150/LYS for HPV vaccination of pre-adolescent girls compared to no intervention. The cost of combined strategy of HPV vaccination and current screening was US$ 2843/LYS compared to screening alone | Current screening would be good value for money compared with no intervention but would be inefficient compared with vaccination |
Mostafa et al. [61] | Egyptian | Egyptian | International | International | NGO | NR | Using Safety-engineered syringes was dominant option (less costly and more effective) with an ICER of US$ − 1802/QALY gained compared to conventional syringes | Using Safety-engineered syringes is more effective and cost-saving strategy |
Mostafa et al. [62] | Egyptian | Egyptian and international | NR | International | NGO | NR | Using Safety-engineered syringes was dominant option (less costly and more effective) with an ICER of Int. $ − 18,650/QALY gained compared to conventional syringes | Using Safety-engineered syringes is cost saving prevention policy |
Nahvijou et al. [63] | Iranian and assumptions | Iranian and international | Iranian and international | International | Academia | 1–2 GDP/C (US$ 6631–13,262 in 2013) | Compared with no-screening strategy, the most cost-effective strategy (ICER of US$ 8875/QALY) was HPV DNA testing beginning at age 35 years with 10-year screening intervals | Organized cervical screening with HPV DNA testing for women is recommended, beginning at age 35 and repeated every 10 or 5 years |
Okem et al. [64] | Turkish | Turkish | International | NA | NR | NR | ICER of NIPT was PPP 17,235,174/Down syndrome cases detected compared to combined test. ICER of NIPT following combined test was PPP 6,873,082/Down syndrome cases detected compared to combined test | NIPT leads to very high costs despite its high effectiveness. Thus, cost of NIPT should be decreased |
Ornoy et al. [65] | Local and assumptions | Local | NA | NA | None | NA | The benefit cost ratio was 7.02 and, assuming only 50% success of treatment, it was 3.51 | National screening program offers a very high cost benefit ratio |
Ranson et al. [66] | Local, regional and international | Local, regional and international | Local, regional and international | NR | NGO | NR | Tax increases to raise the real price of cigarettes by 10% worldwide would prevent between 5 and 16 million tobacco-related deaths, and could cost US$ 3–70/DALY saved in LMIC. NRT and a package of non-price interventions other than NRT were also cost-effective in LMIC, at US$ 280–870 and US$ 36–710/DALY, respectively. In HIC, price increases were found to have a cost-effectiveness of US$ 83–2771/DALY, NRT US$ 750–7206/DALY and other non-price interventions US$ 696–13,924/DALY | Tobacco control policies, particularly tax increases on cigarettes, are cost-effective relative to other health interventions |
Rashidian et al. [67] | Iranian | International | National | NA | Government | NR | Caspian-Alborz device was the most cost-effective alternative with an average cost-effectiveness from US$ 33 to 333/treatment of every one cubic meter of infectious waste in various conditions | There is more than one cost-effective device for different conditions and times in a country |
Rezaei-Hemami et al. [68] | Iranian | Iranian and international | Iranian and international | NA | Academia | NR | The most cost-effective interventions were the use of insecticide-treated nets, Larviciding, surveillance for diagnosis and treatment of patients in less than 24 h, and indoor residual spraying, respectively | Insecticide-treated net is the most cost effective intervention |
Saygili et al. [69] | Turkish | Local and international | NR | NA | NR | NR | From a societal perspective, palliative care services provided at hospital IPD were more cost‐effective. From a patient perspective, home healthcare was more cost‐effective with an ICER of US$ 33.43 and US$ -18.30/QALY compared to hospital IPD and comprehensive palliative care center, respectively | Hospital inpatient palliative care is more cost‐effective compared with other alternatives from societal perspective |
Shamshiri et al. [70] | Iranian | Iranian | NR | Iranian | Academia | NR | ICERs for screening programs with different TSH cut-off points versus no screening were similar (US$ − 4.5 ± 0.2/DALY) | The current threshold of TSH in the national congenital hypothyroidism screening program is the most cost-effective threshold |
Sharma et al. [71] | Lebanese and international | Lebanese | International | NA | None | 1 GDP/C (Int. $ 17,462 in 2014) | ICERs/LYG were Int. $ 80,670 for annual cytologic screening at 20% coverage, Int. $ 12,210 for HPV DNA testing screening every 5 years at 50% coverage and Int. $ 16,340 for HPV DNA testing every 4 years at 50% coverage | Screening each 5 and 4 years is cost effective but annually is not |
Shlomai et al. [72] | NR | Local | NA | NR | None | WTP of US$ 50,000–150,000 | The ICER would be US$ 45.1 million/one death case prevented and US$ 15.24 million/QALY | A national lockdown strategy has a moderate advantage in saving lives with extremely high costs and possible overwhelming economic effects |
Shmueli et al. [73] | Local | Local | International | Local | NGO and academia | WTP of US$ 10,000 and 20,000 | ICER/QALY gained by screening was US$ 1464 | Screening presents a good value for the money and should be considered for inclusion in the national list of health services financed publicly |
Sladkevicius et al. [74] | Libyan | National, regional and international | International | NA | Industry | WTP of US$ 4,000 | The expected cost/undiscounted LYG was US$ − 15,500. There would be a 90% return on investment in the screening program since society would gain US$ 1.9 for every invested US$ 1 | Screening program is cost-effective from a societal perspective |
Verguet et al. [75] | Regional and international | International | International | International | NR | 1–3 GDP/C | ICERs/DALY were US$ 12,300 in Djibouti, 41,000 in Mauritania, 41,600 in Somalia and 19,600 in Sudan | Adding HIV pre-exposure prophylaxis is not cost-effective in Djibouti, Mauritania, Somalia, and Sudan due to low levels of HIV burden and high levels of male circumcision |
Vijayaraghavan et al. [76] | National and international | National and international | International | NA | NR | 1–3 GNI/C (US$ 735–2205 in 2002) | The cost/death prevented was US$ 23.6. For every one million US$ invested by donors, an estimated 42,300 deaths were prevented by the campaigns. For the same investment, the catch-up campaign averted 43,700 deaths while the follow-up campaign averted 38,300 deaths | The campaigns were extremely cost-effective and provided excellent returns on investment under all scenarios considered in the analysis |
Vijayaraghavan et al. [77] | Somali | International | International | NA | Donors | 1 GNI/C (US$ 140 in 2010) | The cost-effectiveness ratios were US$ 44/LYS by 1st round, US$ 28/LYS by 2nd round and US$ 34/LYS by both rounds combined. For every US$ 1 million invested in both rounds, an estimated 615 children’s lives, or 29,500 life years, were saved | Child Health Days are very cost-effective strategy for addressing the leading causes of children mortality in a conflict setting like Somalia |
Wilcox et al. [78] | Syrian | Syrian | International | NA | Academia | PPP$ 13,000–38,997 | CERs/LYG were PPP$ 5453 for reformulation of salt content within packaged foods, PPP$ 2201 for combination of health promotion campaign and reformulation of salt content and PPP$ 2125 for combination of reformulation of salt content and labeling of salt content on packaged foods | All salt reduction policies are cost-saving or cost effective |
Yarahmadi et al. [79] | NR | Local | International | NA | NR | NR | Benefit to cost ratios with regard to education and care of patients with mental retardation were lower by 22 times (100% in the public sector), 41 times (100% in the private sector), 32 times (50% in the public sector and 50% in the private sector), 34 times (100% in the public sector day and night), 47 times (50% in the public sector and 50% in the private sector day and night), and 60 times (100% in the private sector day and night) | Newborn screening program for congenital hypothyroidism has been quite effective |
Yosefy et al. [80] | Local | Local and International | NR | Local | NR | 1–3 GDP/C (US$ 16,497–49,491 in 2003) | The implementation of health education program nationwide was likely to save over 2000 lives and US$ 185 million in health care resources alone | It is conceivable that the health education program may be extended not only throughout this country, but also to neighboring countries |
Yosefy et al. [81] | Local | NR | Local | International | Government | NR | The net saving to health services would be US$ 977,993 and the increase in QALYs would be 602 years | Better control of hypertensive patients is cost effective |