What is the value of explicit priority setting for health interventions? A simulation study

Euan Barlow, Alec Morton, Saudamini Dabak, Sven Engels, Wanrudee Isaranuwatchai, Yot Teerawattananon, Kalipso Chalkidou

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
35 Downloads (Pure)


Many countries seek to secure efficiency in health spending through establishing explicit priority setting institutions (PSIs). Since such institutions divert resources from frontline services which benefit patients directly, it is legitimate and reasonable to ask whether they are worth the money. We address this question by comparing, through simulation, the health benefits and costs from implementing two alternative funding approaches – one scenario in which an active PSI enables cost-effectiveness-threshold based funding decisions, and a counterfactual scenario where there is no PSI. We present indicative results for one dataset from the United Kingdom (published in 2015) and one from Malawi (published in 2018), which show that the threshold rule reliably resulted in decreased health system costs, improved health benefits, or both. Our model is implemented in Microsoft Excel and designed to be user-friendly, and both the model and a user guide are made publicly available, in order to enable others to parameterise the model based on the local setting. Although inevitably stylised, we believe that our modelling and results offer a valid perspective on the added value of explicit PSIs.

Original languageEnglish
Pages (from-to)460-483
Number of pages24
JournalHealth Care Management Science
Issue number3
Early online date28 May 2022
Publication statusPublished - Sept 2022


  • priority setting institutions
  • health technology assessment
  • cost-effectiveness thresholding
  • portfolio decision analysis
  • simulation


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