When is elimination of an infectious disease cost- effective? An analytical framework to guide elimination priorities
File(s)
Published version
Author(s)
Ahmed, Sayara
Mangal, Tara D
Hallett, Timothy B
Turner, Hugo
Type
Journal Article
Abstract
Background
Elimination targets for infectious diseases are increasingly common in global health, yet the economic rationale for pursuing elimination is often assumed rather than rigorously assessed. Existing evaluations frequently emphasise future cost savings or broader economic benefits while overlooking health opportunity costs—the health that could have been gained had resources been allocated elsewhere. This study aimed to develop an analytical framework to investigate when disease elimination generates positive net health benefit (NHB) and to illustrate how key factors interact to shape this assessment.
Methods
We constructed a generalisable analytical framework incorporating ten factors related to intervention and disease costs, intrinsic disease/intervention characteristics, and stakeholder viewpoints and evaluation parameters. The framework was applied to create an exemplar model that showed how these factors jointly influence the NHB of achieving elimination. This was evaluated across wide parameter ranges informed by the literature, using different cost-effectiveness thresholds, discount rates, and time horizons.
Results
The framework revealed distinct regions of parameter space in which elimination yield positive NHB. The cost effectiveness threshold, discount rates, disease burden, and intervention impact were strong determinants of NHB. In particular, lower thresholds, higher discount rates, and shorter time horizons reduced the likelihood that elimination would generate positive NHB. The framework also showed that elimination may be cost effective in some settings but not in others, even for the same disease, due to differences in costs, burden, and opportunity costs.
Conclusions
Disease elimination is not always a good investment; its value depends on the interplay between disease characteristics, programme costs, and the health opportunity costs of resource use. The proposed framework provides a transparent, health opportunity cost-based structure for evaluating elimination strategies and supports more robust, context-specific priority setting on elimination targets in global health.
Elimination targets for infectious diseases are increasingly common in global health, yet the economic rationale for pursuing elimination is often assumed rather than rigorously assessed. Existing evaluations frequently emphasise future cost savings or broader economic benefits while overlooking health opportunity costs—the health that could have been gained had resources been allocated elsewhere. This study aimed to develop an analytical framework to investigate when disease elimination generates positive net health benefit (NHB) and to illustrate how key factors interact to shape this assessment.
Methods
We constructed a generalisable analytical framework incorporating ten factors related to intervention and disease costs, intrinsic disease/intervention characteristics, and stakeholder viewpoints and evaluation parameters. The framework was applied to create an exemplar model that showed how these factors jointly influence the NHB of achieving elimination. This was evaluated across wide parameter ranges informed by the literature, using different cost-effectiveness thresholds, discount rates, and time horizons.
Results
The framework revealed distinct regions of parameter space in which elimination yield positive NHB. The cost effectiveness threshold, discount rates, disease burden, and intervention impact were strong determinants of NHB. In particular, lower thresholds, higher discount rates, and shorter time horizons reduced the likelihood that elimination would generate positive NHB. The framework also showed that elimination may be cost effective in some settings but not in others, even for the same disease, due to differences in costs, burden, and opportunity costs.
Conclusions
Disease elimination is not always a good investment; its value depends on the interplay between disease characteristics, programme costs, and the health opportunity costs of resource use. The proposed framework provides a transparent, health opportunity cost-based structure for evaluating elimination strategies and supports more robust, context-specific priority setting on elimination targets in global health.
Date Issued
2026-12-01
Date Acceptance
2026-05-25
Citation
Cost Effectiveness and Resource Allocation, 2026, 24 (1)
ISSN
1478-7547
Publisher
BMC
Journal / Book Title
Cost Effectiveness and Resource Allocation
Volume
24
Issue
1
Copyright Statement
© The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1186/s12962-026-00777-2
Subjects
Elimination
Economic evaluation
Framework
Value for money
Publication Status
Published
Article Number
ARTN 98
Date Publish Online
2026-05-28