Cost effectiveness and strategic planning (WHO-CHOICE)

Generalized Cost-Effectiveness Analysis

The use of cost-effectiveness analysis within decision making processes in health is increasingly common globally. However, a series of methodological shortcomings may limit the practical application of cost-effectiveness analysis results.

Two examples of this are methodological differences between studies that limit comparability, and use of the current practice as a comparator, which implicitly assumes current resource use is efficient. Generalized Cost-Effectiveness Analysis (GCEA) was developed to overcome such shortcomings of traditional cost-effectiveness analysis.

The GCEA approach enables both existing and new interventions to be evaluated simultaneously. The comparator used in GCEA is a hypothetical “null” scenario, where the impacts of all currently implemented interventions are removed. Uniquely, this method allows existing and new interventions to be analysed at the same time.

Previous cost-effectiveness analyses have been restricted to assessing the efficiency of adding a single new intervention to the existing set, or replacing one existing intervention with an alternative. Using WHO-CHOICE, the analyst is no longer constrained by what is already being done, and policymakers can revisit and revise past choices if necessary and feasible. They will have a rational basis for deciding to reallocate resources between interventions to achieve social objectives.

For more information on Generalized Cost-Effectiveness Analysis, download the WHO Guide:

Further information:


  • Health Systems Financing
    Cost-effectiveness analysis and its implementation via CHOICE is part of health systems financing.