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Table 5 Factors influencing variation in cost-effectiveness

From: Economic evaluations of non-communicable disease interventions in developing countries: a critical review of the evidence base

Influencing factor Examples
Epidemiological environment  
Prevalence of condition Screening and referral programs for breast cancer
Incidence of condition Preventive measures for many injuries
Existence of competing risks of synergisms Some surgical interventions: among the very young or elderly, competing risks reduce the cost-effectiveness of some targeted interventions
Individual characteristics  
Age Cancer treatment: more cost-effective for younger patients
Tendency to compliance Anti-hypertensive medication
Tendency to self-refer Diabetes control
Level of risk factors Hypertension and hyperlipdemia
Individual variation in values Attitude toward disability relative to risk of death; can lead to individual differences in intervention effectiveness
System characteristics  
Local costs of non-traded inputs to health care system Real costs of care intensive interventions (such as hospitalisation after trauma) are low where wages are low, because most health care personnel are relatively immobile
Generalised systemic competence Cost-effectiveness at the margin of some interventions in a system with a low level of professionalism and capacity may be much higher than in more developed systems
Discount rate Where discount rates are high, interventions with payoffs well into the future (such as treatment of obesity) become relatively less attractive.
  1. Source: adapted from Table 1–4 in Jamison [54].