{
  "abstract": "Objective Non-disease-specific WHO-CHOICE (CHOosing Interventions that are Cost-Effective) unit costs are often used in cost and cost-effectiveness studies in the absence of country-specific data. This study aims to compare reported country-specific disease costs and the corresponding WHO-CHOICE estimates, using generically defined ‘diarrhoea’ (including rotavirus diarrhoea) and pathogen-specific ‘respiratory syncytial virus (RSV)’ disease in children as examples.Methods We updated systematic reviews for both diseases in low-income (LICs), lower middle-income (LMICs) and upper middle-income (UMICs) countries. Diarrhoeal (including a subanalysis of rotavirus-specific diarrhoea) and RSV-specific outpatient and inpatient costs per episode in children were extracted and compared with WHO-CHOICE estimates in the same countries. All costs were updated to 2022 international dollar values. If a consistent pattern of underestimation or overestimation was identified, we quantified the magnitude of the discrepancy as the ratio of published disease-specific costs and corresponding WHO-CHOICE-based estimates.Results Out of 1979 records identified, 23 cost studies were included. Including previous reviews, we retained 31 diarrhoea and 16 RSV studies for comparison. WHO-CHOICE-based direct medical costs were similar for diarrhoeal disease (including rotavirus diarrhoea), but lower for RSV-related disease. We estimated the cost per episode of diarrhoea and RSV in 128 countries. RSV outpatient costs were adjusted by multiplying WHO-CHOICE costs by 6.89 (95% uncertainty interval: 5.58 to 8.58) in LICs and LMICs and 5.87 (4.95 to 6.96) in UMICs; RSV inpatient costs were multiplied by 1.43 (1.01 to 2.01) and 1.36 (0.82 to 2.27), respectively.Conclusion While informative for economic evaluations, WHO-CHOICE-based cost estimates should be used cautiously. Our analysis shows they aligned well with empirical studies for diarrhoeal disease but underestimated the costs of RSV-related disease. For diseases with few country-specific costing studies, comparing findings of the empirical studies with WHO-CHOICE estimates is crucial before conducting economic evaluations for countries without data. We propose a simple approach for calculating adjustment factors for WHO-CHOICE estimates when empirical data on disease-specific diagnosis and treatment costs are limited.",
  "authors": [
    {
      "affiliations": [
        "Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, Connecticut, USA",
        "Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA"
      ],
      "name": "Xiao Li"
    },
    {
      "affiliations": [
        "Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, Connecticut, USA"
      ],
      "name": "Joke Bilcke"
    },
    {
      "affiliations": [
        "Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA",
        "Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium"
      ],
      "name": "Ernest O Asare"
    },
    {
      "affiliations": [
        "Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium"
      ],
      "name": "Catherine Wenger"
    },
    {
      "affiliations": [
        "Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA",
        "Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium"
      ],
      "name": "Jiye Kwon"
    },
    {
      "affiliations": [
        "Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium",
        "Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital University Medical Centre, Utrecht, Netherlands"
      ],
      "name": "Louis Bont"
    },
    {
      "affiliations": [
        "Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, Connecticut, USA"
      ],
      "name": "Philippe Beutels"
    },
    {
      "affiliations": [
        "Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA",
        "Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium"
      ],
      "name": "Virginia E Pitzer"
    }
  ],
  "title": "How well do disease-specific studies and WHO-CHOICE cost estimates align? Example of estimating cost per episode of diarrhoea and respiratory syncytial virus in 128 low-income and middle-income countries",
  "uid": "8448b559-7a8a-5cee-8e92-c5d66fb97521"
}