Cost-effectiveness analysis is a relative measure of ‘value for money’, where its principle outcome the incremental cost-effectiveness ratio is benchmarked against thresholds to inform resource allocation decisions. Currently, Malaysia like many low- and middle-income countries (LMICs) has not formally defined cost-effectiveness thresholds and utilises so-called “WHO-CHOICE” GDP per capita-based thresholds proposed by the Commission on Macroeconomics in Health for global and regional allocation decisions. Yet World Health Organization economists recently argued that the use of such GDP per capita-based thresholds as rules for country-level decision-making is inappropriate, suggesting that countries develop their own thresholds in a way that accounts for the local decision context and budget implications. Using these GDP per capita-based thresholds, rotavirus vaccines are widely regarded as cost-effective interventions in LMICs. However, high vaccine prices remain a barrier towards rotavirus vaccine introduction.
In a recent article published in Health Policy and Planning entitled Thresholds for decision-making: Informing the cost-effectiveness and affordability of rotavirus vaccines in Malaysia, Dr Tharani Loganathan, a Medical Lecturer at the Department of Social and Preventive Medicine, University Malaya, together with co-authors Assoc. Prof. Dr Ng Chiu Wan, from the Social and Preventive Medicine Department of University Malaya, Professor Dr Lee Way Seah from the Department of Paediatrics, University of Malaya, Dr. Mark Jit, Professor of Vaccine Epidemiology from London School of Tropical Medicine and Hygiene, Assistant Professor of Global Health from Harvard TH Chan School of Public Health, and Dr Raymond CH Hutubessy, Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, explore the justification and implications of using different cost-effectiveness thresholds in Malaysia in terms of cost-effectiveness, budget impact and vaccine pricing, using rotavirus vaccination as a case study. This work is extremely timely and has the potential to be of great influence, as it may represent the first time these recommendations from World Health Organization economists are applied in practice.