9. Generalised cost-effectiveness analysis (GCEA)

To better allocate scarce resources in the healthcare sector, decision-makers across the world rely on cost-effectiveness analyses (CEA). In short, CEA compares the costs and effectiveness of two or more policy alternatives, where one typically represents the status quo.

The literature on CEA is vast, yet practical application of results is often limited due to several methodological shortcomings:

• CEAs in the health sector often focus on a particular disease/risk factor/health problem. Results may therefore not be useful for decision-makers facing multiple demands (e.g. social health insurers must decide what ‘package’ of services to provide with a fixed level of contributions). In this scenario, decision-makers require comparisons of different types of interventions.

• CEAs typically focus on how small, incremental changes in resources should be allocated to improve overall outcomes, or whether a new technology is more cost-effective than the status quo. These types of studies therefore assume current resource allocation is efficient.

• Most CEA studies are context-specific and thus omit the impact the level and quality of health infrastructure has on outcomes.

• Evaluation of costs and outcomes are largely evaluated in isolation from current interventions.

• Finally, the methodologies across CEA studies differ which limits comparability.

In response to these concerns, the WHO developed a generalised CEA (GCEA). The comparator in the GCEA model is “business as usual”, therefore the impact of all currently implemented interventions are removed. Consequently, the method allows current and new interventions to be analysed simultaneously.