iDSI Reference Case for Economic Evaluation
The iDSI Reference Case is a principle-based approach to guide the planning, conduct and reporting of economic evaluations. It provides decision makers with relevant and reliable ways to determine the likely implications of implementing a treatment or health service in specific contexts. Its primary focus is on meeting the informational needs of decision makers in low- and middle-income countries (LMICs). It builds on the methods and approaches of the National Institute for Health and Care Excellence (NICE) in the UK, the Health Intervention and Technology Assessment Program (HITAP) in Thailand and the World Health Organization, the iDSI Reference Case helps countries to calculate value for money and to consistently spend their health budgets effectively.
Some of the biggest decisions that must be made within health systems are on how to spend the health budget. These unavoidable decisions will have large consequences. Understanding the expected clinical effect of differing health treatments and services, and how much it will cost to achieve that clinical effect, is called determining the value. When people know the value of the different options, decision making becomes easier and money can be spent more effectively on health.
Explore the following sections:
Using the reference case
The iDSI reference case is an aid to thinking. It provides a systematic way in which to conduct and report on economic evaluations, but also the flexibility to tailor the methodology to specific needs and setting.
The principles of the iDSI reference case describe how to undertake economic evaluations that are fit for purpose, but don’t specify particular metrics or parameter values. The methodological specifications are a non-exhaustive set of options that enable the economic evaluation to adhere to the principles. These principles each contain a suggested implementation methodology and guidance for reporting.
Explore the practical application of the iDSI Reference Case in different settings, including a summary of the case studies highlighted below.
Informing decisions in global health
Claxton, K., Ochalek, J., Revill, P., Rollinger, A. and Walker, D. (2016) Informing Decisions in Global Health. Cost per DALY thresholds and health opportunity costs.
Using cost-effectiveness thresholds
Revill P, Walker S, Madan J, et al. (2014) Using cost-effectiveness thresholds to determine value for money in low- and middle-income country healthcare systems: Are current international norms fit for purpose? CHE Research Paper 98.
Country-level cost-effectiveness thresholds
Woods B, Revill P, Sculpher M and Claxton K. (2015) Country-level cost-effectiveness thresholds: Initial estimates and the need for further research. CHE Research Paper 109.
Cost-effectiveness workshop summary
Within-country threshold estimation: Indonesia
Led by Marc Suhrcke (University of York), within-country analysis is being conducted to determine cost-effectiveness thresholds in LMICs. Related publications and reports to date include:
Exploration of non-budgetary constraints in a LMIC setting
Peter Smith (Imperial College London) is leading on developing a methods framework for assessing the cost-effectiveness of different delivery platforms (e.g. primary vs. secondary care) in the context of Universal Health Coverage. Related Publications and reports so far include:
Departures from cost-effectiveness recommendations
Hauck, K.D., Thomas, R and Smith, P.C. (2016) Departures from cost-effectiveness recommendations: The impact of health system constraints on priority setting
Including human resource constraints
Thongkong, N, van Baal, P. and Severens, J.L. (2015) Including human resource constraints in health economic evaluations.
The politics of priority setting
Hauck, K and Smith, P. (2015) The politics of priority setting in Health: A political economy perspective. CGD Working Paper.
Cost-effectiveness workshop summary
Using the RC for transmission models, and presenting disaggregated social perspectives
Professor Anna Vassall and colleagues at LSHTM are leading an exploration of presenting the disaggregated social perspectives when conducting economic evaluations of multi-sectoral interventions, and the application of the iDSI RC to transmission model based economic evaluation.
- Identifying key challenges and solutions in applying the iDSI Reference Case to economic evaluations using transmission models with a particular focus on principles 11 (equity) and 8 (heterogeneity)
- Developing methods for reporting and analysing the “disaggregated societal perspective” in the Reference Case (principle no. 7)
The initial research that led to the development of the IDSI Reference Case found wide variation in methodological quality in economic evaluations conducted in LMIC settings.
The Reference Case consolidated this research and created central principles for economic evaluation, but further methodological research is needed to ensure economic evaluation is a useful tool for good decision making in health in LMICs.
iDSI welcomes further initiatives related to methodological research and utilisation of analysis.
Guidelines for benefit-cost analysis
Harvard T.H. Chan School of Public Health are developing guidelines to encourage the conduct of high quality benefit‐cost analyses.
Global health cost consortium
The Global Health Cost Consortium will provide decision-makers with improved resources to estimate the costs of HIV and tuberculosis (TB) programs.