Health state valuation in low- and middle-income countries: a systematic review of the literature

Value Health. 2013 Sep-Oct;16(6):1091-9. doi: 10.1016/j.jval.2013.05.006. Epub 2013 Jul 16.


Objective: Cost-utility analysis is widely used in high-income countries to inform decisions on efficient health care resource allocation. Cost-utility analysis uses the quality-adjusted life-year as the outcome measure of health. High-income countries have undertaken health state valuation (HSV) studies to determine country-specific utility weights to facilitate valuation of health-related quality of life. Despite an evident need, however, the extent of HSVs in low- and middle-income countries (LMICs) is unclear.

Methods: The literature was searched systematically by using four databases and additional Web searches to identify HSV studies carried out in LMICs. The Preferred Reporting System for Systematic Reviews and Meta-Analysis (PRISMA) strategy was followed to ensure systematic selection of the articles.

Results: The review identified 17 HSV studies from LMICs. Twelve studies were undertaken in upper middle-income countries, while lower middle- and low-income countries contributed three and two studies, respectively. There were 7 generic HSV and 10 disease-specific HSV studies. The seven generic HSVs included five EuroQol five-dimensional questionnaire, one six-dimensional health state short form (derived from short-form 36 health survey), and one Assessment of Quality of Life valuations. Time trade-off was the predominant valuation method used across all studies.

Conclusions: This review found that health state valuations from LMICs are uncommon and utility weights are generally unavailable for these countries to carry out health economic evaluation. More HSV studies need to be undertaken in LMICs to facilitate efficient resource allocation in their respective health systems.

Keywords: LMIC; QALY; health state valuation; preference; utility.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Cost-Benefit Analysis
  • Developing Countries*
  • Health Status*
  • Humans
  • Patient Preference
  • Quality of Life*
  • Quality-Adjusted Life Years
  • Resource Allocation / economics*
  • Surveys and Questionnaires