Page 159 - Genomic Medicine in Emerging Economies

148 CHAPTER 8: E c o n omic Evaluation and Cost-Effectiveness Analysis

Table 8.1 Low-Income European Countries and Their Corresponding GNI
Values
Country GNI
Moldova 2,220
Ukraine 2,620
Armenia 3,880
Kosovo 3,950
Georgia 4,160
Albania 4,290
Bosnia and Herzegovina 4,680
Former Yugoslav Republic of Macedonia (FYROM) 5,140
Serbia 5,500
Belarus 6,460
Azerbaijan 6,560
Bulgaria 7,220
Montenegro 7,240
Turkey 9,950
Russia 11,400
Kazakhstan 11,580
Romania 12,670

decision-making in public healthcare policy, its cost-effectiveness must be
determined. In short, cost-effectiveness analysis (CEA) is a form of economic
analysis that compares the relative costs and outcomes (effects) of different
courses of action (Fragoulakis et al., 2015). Cost-effectiveness analysis is dis-
tinct from cost-benefit analysis, which assigns a monetary value to the measure
of effect. In the context of pharmacoeconomics, the cost-effectiveness of a ther-
apeutic or preventive intervention is the ratio of the cost of the intervention
to a relevant measure of its effect. Cost refers to the resource expended for the
intervention, usually measured in monetary terms, such as US dollar, British
pound, and so on. The measure of effects depends on the intervention being
considered. A special case of CEA is the cost-utility analysis, where the effects
are measured in terms of years of full health lived, using a measure such as
quality-adjusted life years (QALY) or disability-adjusted life years. Cost-effec-
tiveness is typically expressed as an incremental cost-effectiveness ratio (ICER),
the ratio of change in costs to the change in effects.
Today, cost-effectiveness studies have mostly been done from the perspective of
high-income countries, even though an argument can be made that the analy-
ses could be much more important to low-income countries where the conse-
quence of expending scarce resources on technology that is not cost-effective
has a much higher opportunity cost. Unfortunately, there is also a shortage of
health economists and modelers in low-income countries. Apart from the dif-
ferences in current drug prices and resource utilization in different countries,
another important parameter to determine the cost-effectiveness of a certain