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Table 1 Comparison of characteristics of laparoscopic cholecystectomy (LC) and renal dialysis used in the case scenario.

From: The greatest happiness of the greatest number? Policy actors' perspectives on the limits of economic evaluation as a tool for informing health care coverage decisions in Thailand

  Severity of disease and importance of the intervention: are there alternatives? Equity of access improvement Cost-effectiveness based on economic evaluation* Financial impact on government budget
  + ++ +++ -
LC for gallbladder disease Medical treatment and open conventional (OC) surgery are both available. 13% of patients in the country undergoing LC are under UC but have to pay a proportion of the cost. An alternative (OC) is available without a charge. Compared to open surgery, the incremental cost-effectiveness ratio (ICER) for LC is less than 1 Thai GDP per capita and so considered cost-effective. Relatively very small budget needed if it is to be included in the UC package. If included the indirect and direct non medical costs to households would also be reduced substantially.
  +++ +++ - +++
Dialysis for end-stage renal disease The availability of kidney donors is very limited. Without dialysis or kidney transplantation patients will die within 3–6 months. Less than 5% of patients undergoing dialysis are under UC and have to pay the full cost. There is no alternative available for them. Compared to 'palliative care', ICER for dialysis is higher than 5 times Thai GDP per capita and so considered non cost-effective. Very huge financial impact on the overall UC budget.
  1. *A report from the Commission on Macroeconomics and Health suggests the use of a threshold three times that of Gross Domestic Product (GDP) per capita as a basis for interpreting whether an intervention is cost-effective and should be adopted as a health technology in developing countries [32].
  2. Marks: +++ "very high", ++ "high", +"moderate", – "none".