Methodological variation in economic evaluations conducted in low- and middle-income countries: information for reference case development

PLoS One. 2015 May 7;10(5):e0123853. doi: 10.1371/journal.pone.0123853. eCollection 2015.


Information generated from economic evaluation is increasingly being used to inform health resource allocation decisions globally, including in low- and middle- income countries. However, a crucial consideration for users of the information at a policy level, e.g. funding agencies, is whether the studies are comparable, provide sufficient detail to inform policy decision making, and incorporate inputs from data sources that are reliable and relevant to the context. This review was conducted to inform a methodological standardisation workstream at the Bill and Melinda Gates Foundation (BMGF) and assesses BMGF-funded cost-per-DALY economic evaluations in four programme areas (malaria, tuberculosis, HIV/AIDS and vaccines) in terms of variation in methodology, use of evidence, and quality of reporting. The findings suggest that there is room for improvement in the three areas of assessment, and support the case for the introduction of a standardised methodology or reference case by the BMGF. The findings are also instructive for all institutions that fund economic evaluations in LMICs and who have a desire to improve the ability of economic evaluations to inform resource allocation decisions.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Costs and Cost Analysis / standards*
  • Delivery of Health Care / economics
  • Delivery of Health Care / organization & administration*
  • HIV Infections / economics
  • Humans
  • Malaria / economics
  • Models, Econometric*
  • Socioeconomic Factors
  • Tuberculosis / economics
  • Vaccines / economics


  • Vaccines

Grant support

The Health Intervention and Technology Assessment Program (HITAP) is funded by the Thailand Research Fund under the senior research scholar on Health Technology Assessment (RTA5580010), the National Health Security Office, the Health System Research Institute and the Bureau of Health Policy and Strategy, Ministry of Public Health. The findings, interpretations and conclusions expressed in this article do not necessarily reflect the views of the above funding agencies. HITAP’s international unit was established with support from the Thai Health-Global Link Initiative Project (TGLIP), the international Decision Support Initiative (funded by the Bill & Melinda Gates Foundation and the Department for International Development, UK), and the Rockefeller Foundation to provide technical assistance on health intervention and technology assessment for governments of low- and middle-income countries. The the Bill & Melinda Gates Foundation had role in study design, data collection and analysis, decision to publish, and preparation of the manuscript.