Cost per DALY averted in low, middleand high‑income countries: evidence from the global burden of disease study to estimate the cost‑effectiveness thresholds

Determining the cost-effectiveness thresholds for healthcare interventions has been a severe challenge
for policymakers, especially in low- and middle-income countries. This study aimed to estimate the cost per
disability-adjusted life-year (DALY) averted for countries with different levels of Human Development Index (HDI) and
Gross Domestic Product (GDP).
Methods: The data about DALYs, per capita health expenditure (HE), HDI, and GDP per capita were extracted for 176
countries during the years 2000 to 2016. Then we examined the trends on these variables. Panel regression analysis
was performed to explore the correlation between DALY and HE per capita. The results of the regression models were
used to calculate the cost per DALY averted for each country.
Results: Age-standardized rate (ASR) DALY (DALY per 100,000 population) had a nonlinear inverse correlation with
HE per capita and a linear inverse correlation with HDI. One percent increase in HE per capita was associated with an
average of 0.28, 0.24, 0.18, and 0.27% decrease on the ASR DALY in low HDI, medium HDI, high HDI, and very high
HDI countries, respectively. The estimated cost per DALY averted was $998, $6522, $23,782, and $69,499 in low HDI,
medium HDI, high HDI, and very high HDI countries. On average, the cost per DALY averted was 0.34 times the GDP
per capita in low HDI countries. While in medium HDI, high HDI, and very high HDI countries, it was 0.67, 1.22, and
1.46 times the GDP per capita, respectively.
Conclusions: This study suggests that the cost-effectiveness thresholds might be less than a GDP per capita in low
and medium HDI countries and between one and two GDP per capita in high and very high HDI countries.