Abstract
Objectives
Financial risk protection (FRP), or the prevention of medical impoverishment, is a
major objective of health systems, particularly in low- and middle-income countries
where the extent of out-of-pocket (OOP) health expenditures can be substantial. We
sought to develop a method that allows decision makers to explicitly integrate FRP
outcomes into their priority-setting activities.
Methods
We used literature review to identify 31 interventions in low- and middle-income countries,
each of which provided measures of health outcomes, costs, OOP health expenditures
averted, and FRP (proxied by OOP health expenditures averted as a percentage of income),
all disaggregated by income quintile. We developed weights drawn from the Z-score
of each quintile-intervention pair based on the distribution of FRP of all quintile-intervention
pairs. We next ranked the interventions by unweighted and weighted health outcomes
for each income quintile. We also evaluated how pro-poor they were by, first, ordering
the interventions by cost-effectiveness for each quintile and, next, calculating the
proportion of interventions each income quintile would be targeted for a given random
budget. A ranking was said to be pro-poor if each quintile received the same or higher
proportion of interventions than richer quintiles.
Results
Using FRP weights produced a more pro-poor priority setting than unweighted outcomes.
Most of the reordering produced by the inclusion of FRP weights occurred in interventions
of moderate cost-effectiveness, suggesting that these weights would be most useful
as a way of distinguishing moderately cost-effective interventions with relatively
high potential FRP.
Conclusions
This preliminary method of integrating FRP into priority-setting would likely be most
suitable to deciding between health interventions with intermediate cost-effectiveness.
Keywords
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Article info
Publication history
Published online: December 07, 2022
Accepted:
September 26,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc.
