Millions Saved (2016) is a new edition of detailed case studies on the attributable impact of global health programs at scale. As an input to the book, this paper provides an independent assessment of the cost-effectiveness of a selection of the cases using ex post information from impact evaluations, with the objective of illustrating how economic evaluation can be used in decision making and to provide further evidence on the extent of health gains produced for the funding provided. We reviewed the evidence and calculated the averted disease burden and cost-effectiveness for a selected group of public health successes, finding that large health gains have been achieved in programs that represent good value for money. Since these cases represent known successes, this is to be expected; however, some key issues emerge. In many cases, estimates of cost-effectiveness are not available for programs at scale and thus estimating efficiency losses and scale-up dynamics is only possible with modeling and by making large assumptions. When assessed in reference to the GDP per capita of the country, many of the programs compare favorably, though the GDP per capita threshold may not be the correct figure for making decisions. Health systems and sectoral interventions, such as those that address access to care or provide resources directly (e.g. cash transfers), present difficulties when estimating standard measures of cost-effectiveness. These difficulties can be partially overcome with high quality studies that evaluate implementation or by using alternative measures of efficiency such as those relating to administrative efficiency. The lessons learned from calculating the cost-effectiveness for many scaled-up programs across a range of health areas and country settings provides lessons for future considerations of the value of scaling up effective health interventions in national health programs.
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