Health gains and fi nancial risk protection aff orded by public fi nancing of selected interventions in Ethiopia: an extended cost-eff ectiveness analysis

摘要

Background The way in which a government chooses to fi nance a health intervention can aff ect the uptake of healthudinterventions and consequently the extent of health gains. In addition to health gains, some policies such as publicudfi nance can insure against catastrophic health expenditures. We aimed to evaluate the health and fi nancial riskudprotection benefi ts of selected interventions that could be publicly fi nanced by the government of Ethiopia.udMethods We used extended cost-eff ectiveness analysis to assess the health gains (deaths averted) and fi nancial riskudprotection aff orded (cases of poverty averted) by a bundle of nine (among many other) interventions that theudGovernment of Ethiopia aims to make universally available. These nine interventions were measles vaccination,udrotavirus vaccination, pneumococcal conjugate vaccination, diarrhoea treatment, malaria treatment, pneumoniaudtreatment, caesarean section surgery, hypertension treatment, and tuberculosis treatment.udFindings Our analysis shows that, per dollar spent by the Ethiopian Government, the interventions that avert the mostuddeaths are measles vaccination (367 deaths averted per $100 000 spent), pneumococcal conjugate vaccination (170 deathsudaverted per $100 000 spent), and caesarean section surgery (141 deaths averted per $100 000 spent). The interventionsudthat avert the most cases of poverty are caesarean section surgery (98 cases averted per $100 000 spent), tuberculosisudtreatment (96 cases averted per $100 000 spent), and hypertension treatment (84 cases averted per $100 000 spent).udInterpretation Our approach incorporates fi nancial risk protection into the economic evaluation of health interventionsudand therefore provides information about the effi ciency of attainment of both major objectives of a health system:udimproved health and fi nancial risk protection. One intervention might rank higher on one or both metrics thanudanother, which shows how intervention choice—the selection of a pathway to universal health coverage—mightudinvolve weighing up of sometimes competing objectives. This understanding can help policy makers to selectudinterventions to target specifi c policy goals (ie, improved health or fi nancial risk protection). It is especially relevantudfor the design and sequencing of universal health coverage to meet the needs of poor populations.