Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness

PLoS One. 2017 Aug 10;12(8):e0182951. doi: 10.1371/journal.pone.0182951. eCollection 2017.


Background: Cost-effectiveness rankings of health interventions are useful inputs for national healthcare planning and budgeting. Previous comprehensive rankings for low- and middle- income countries were undertaken in 2005 and 2006, accompanying the development of strategies for the Millennium Development Goals. We update the rankings using studies published since 2000, as strategies are being considered for the Sustainable Development Goals.

Methods: Expert systematic searches of the literature were undertaken for a broad range of health interventions. Cost-effectiveness results using Disability Adjusted Life-Years (DALYs) as the health outcome were standardized to 2012 US dollars.

Results: 149 individual studies of 93 interventions qualified for inclusion. Interventions for Reproductive, Maternal, Newborn and Child Health accounted for 37% of interventions, and major infectious diseases (AIDS, TB, malaria and neglected tropical diseases) for 24%, consistent with the priorities of the Millennium Development Goals. More than half of the interventions considered cost less than $200 per DALY and hence can be considered for inclusion in Universal Health Care packages even in low-income countries.

Discussion: Important changes have occurred in rankings since 2006. Priorities have changed as a result of new technologies, new methods for changing behavior, and significant price changes for some vaccines and drugs. Achieving the Sustainable Development Goals will require LMICs to study a broader range of health interventions, particularly in adult health. Some interventions are no longer studied, in some cases because they have become usual care, in other cases because they are no longer relevant. Updating cost-effectiveness rankings on a regular basis is potentially a valuable exercise.

MeSH terms

  • Adult
  • Child
  • Child Health Services* / economics
  • Communicable Diseases* / economics
  • Cost-Benefit Analysis
  • Developing Countries*
  • Disabled Persons*
  • Female
  • Humans
  • Income
  • Infant, Newborn
  • Maternal Health Services* / economics
  • Poverty
  • Quality-Adjusted Life Years

Grants and funding

This study was conducted as part of the Disease Control Priorities project, funded by the Bill & Melinda Gates Foundation (Principal Investigator: DJ). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.