@article {Leeche001850, author = {Ashley A Leech and David D Kim and Joshua T Cohen and Peter J Neumann}, title = {Are low and middle-income countries prioritising high-value healthcare interventions?}, volume = {5}, number = {2}, elocation-id = {e001850}, year = {2020}, doi = {10.1136/bmjgh-2019-001850}, publisher = {BMJ Specialist Journals}, abstract = {Introduction Since resources are finite, investing in services that produce the highest health gain {\textquoteleft}return on investment{\textquoteright} is critical. We assessed the extent to which low and middle-income countries (LMIC) have included cost-saving interventions in their national strategic health plans.Methods We used the Tufts Medical Center Global Health Cost-Effectiveness Analysis Registry, an open-source database of English-language cost-per-disability-adjusted life year (DALY) studies, to identify analyses published in the last 10 years (2008{\textendash}2017) of cost-saving health interventions in LMICs. To assess whether countries prioritised cost-saving interventions within their latest national health strategic plans, we identified 10 countries, all in sub-Saharan Africa, with the highest measures on the global burden of disease scale and reviewed their national health priority plans.Results We identified 392 studies (63\%) targeting LMICs that reported 3315 cost-per-DALY ratios, of which 207 ratios (6\%) represented interventions reported to be cost saving. Over half (53\%) of these targeted sub-Saharan Africa. For the 10 countries we investigated in sub-Saharan Africa, 58\% (79/137) of cost-saving interventions correspond with priorities identified in country plans. Alignment ranged from 95\% (21/22 prioritised cost-saving ratios) in South Africa to 17\% (2/12 prioritised cost-saving ratios) in Cameroon. Human papillomavirus vaccination was a noted priority in 70\% (7/10) of national health prioritisation plans, while 40\% (4/10) of countries explicitly included prenatal serological screening for syphilis. HIV prevention and treatment were stated priorities in most country health plans, whereas 40\% (2/5) of countries principally outlined efforts for lymphatic filariasis. From our sample of 45 unique interventions, 36\% of interventions (16/45) included costs associated directly with the implementation of the intervention.Conclusion Our findings indicate substantial variation across country and disease area in incorporating economic evidence into national health priority plans in a sample of sub-Saharan African countries. To make health economic data more salient, the authors of cost-effectiveness analyses must do more to reflect implementation costs and other factors that could limit healthcare delivery.}, URL = {https://gh.bmj.com/content/5/2/e001850}, eprint = {https://gh.bmj.com/content/5/2/e001850.full.pdf}, journal = {BMJ Global Health} }