Reference Case Guidelines for Benefit-Cost Analysis in Global Health and Development

Benefit-cost analysis and other forms of economic evaluation are powerful tools, encouraging the systematic collection and assessment of the evidence needed to support sound policy decisions. In low-and middle-income countries, where resources are very scarce and needs are very great, such decisions are particularly difficult and economic evaluation can be especially useful. If not well conducted and clearly reported, however, these studies can lead to erroneous conclusions. Differences in analytic methods and assumptions can also obscure important differences in policy impacts.Recognizing these challenges, a team of experts developed reference case guidelines to increase the comparability of benefit-cost analyses, improve their quality, and expand their use. The development process involved extensive participation from stakeholders as well as experts, including both practitioners and consumers, incorporating a variety of perspectives. The resulting guidelines provide an overview of the analytic framework, including its conceptual underpinnings and its implementation. They also provide specific recommendations in seven areas: (a) comparing values across countries and over time; (2) valuing mortality risk reductions; (3) valuing nonfatal health risk reductions; (4) valuing changes in time use; (5) assessing the distribution of impacts; (6) accounting for uncertainty and nonquantifiable impacts; and (7) summarizing and presenting the results. The goal is to support the conduct of high-quality analyses that promote understanding of difficult trade-offs and support evidence-based decisions.