Preventing Medical Impoverishment with CEA

Headshots of Nathaniel Hendrix (top) and Stéphane Verguet (bottom) with background

Harvard researchers led by postdoctoral fellow Nathaniel Hendrix and CHDS’ Stéphane Verguet developed a novel method to help decision-makers in low- and middle-income countries (LMICs) include the risk of medical impoverishment in their healthcare priority-setting activities. Financial risk protection, which aims to prevent medical impoverishment, is a crucial objective for health systems in LMICs where out-of-pocket health expenditures can be significant.

The team’s literature review identified 31 healthcare interventions in LMICs, each providing data on health outcomes, costs, out-of-pocket health expenditures averted, and change in the risk of medical impoverishment. They measured financial risk protection as out-of-pocket health expenditures averted as a percentage of income. The team then developed a set of weights that emphasized the role of financial risk protection in priority setting in LMICs.

Their results revealed that using these weights led to priority setting that better meets the needs of low-income patients compared with priority setting using standard cost-effectiveness with no distributional component. Most of the reordering brought about by the inclusion of the weights occurred in interventions with moderate cost-effectiveness, suggesting that these weights could be most helpful in distinguishing moderately cost-effective interventions with relatively high potential to avert medical impoverishment. This preliminary method of incorporating weights based on financial risk protection into priority-setting might be best suited for deciding among health interventions with intermediate cost-effectiveness, ultimately helping to reduce medical impoverishment in low- and middle-income countries.

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