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Epidemiological environment
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Prevalence of condition
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Screening and referral programs for breast cancer
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Incidence of condition
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Preventive measures for many injuries
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Existence of competing risks of synergisms
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Some surgical interventions: among the very young or elderly, competing risks reduce the cost-effectiveness of some targeted interventions
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Individual characteristics
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Age
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Cancer treatment: more cost-effective for younger patients
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Tendency to compliance
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Anti-hypertensive medication
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Tendency to self-refer
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Diabetes control
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Level of risk factors
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Hypertension and hyperlipdemia
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Individual variation in values
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Attitude toward disability relative to risk of death; can lead to individual differences in intervention effectiveness
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System characteristics
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Local costs of non-traded inputs to health care system
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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
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Generalised systemic competence
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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
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Discount rate
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Where discount rates are high, interventions with payoffs well into the future (such as treatment of obesity) become relatively less attractive.
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