title: The International Decision Support Initiative Reference Case for Economic Evaluation: An Aid to Thought.
abstract: BACKGROUND
  Policymakers in high-, low-, and middle-income countries alike face challenging choices about resource allocation in health. Economic evaluation can be useful in providing decision makers with the best evidence of the anticipated benefits of new investments, as well as their expected opportunity costs-the benefits forgone of the options not chosen. To guide the decisions of health systems effectively, it is important that the methods of economic evaluation are founded on clear principles, are applied systematically, and are appropriate to the decision problems they seek to inform.
  
  
  METHODS
  The Bill and Melinda Gates Foundation, a major funder of economic evaluations of health technologies in low- and middle-income countries (LMICs), commissioned a "reference case" through the International Decision Support Initiative (iDSI) to guide future evaluations, and improve both the consistency and usefulness to decision makers.
  
  
  RESULTS
  The iDSI Reference Case draws on previous insights from the World Health Organization, the US Panel on Cost-Effectiveness in Health Care, and the UK National Institute for Health and Care Excellence. Comprising 11 key principles, each accompanied by methodological specifications and reporting standards, the iDSI Reference Case also serves as a means of identifying priorities for methods research, and can be used as a framework for capacity building and technical assistance in LMICs.
  
  
  CONCLUSIONS
  The iDSI Reference Case is an aid to thought, not a substitute for it, and should not be followed slavishly without regard to context, culture, or history. This article presents the iDSI Reference Case and discusses the rationale, approach, components, and application in LMICs.
authors.affiliation: PRICELESS SA, Wits Rural Public Health and Health Transitions Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa. Electronic address: tommy.d.wilkinson@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wilkinson
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sculpher
authors.affiliation: Department of Economics and Centre for Health Economics, University of York, York, UK.
authors.forename: Karl
authors.initials: K
authors.lastname: Claxton
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Revill
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Briggs
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Cairns
authors.affiliation: Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand.
authors.forename: Yot
authors.initials: Y
authors.lastname: Teerawattananon
authors.affiliation: Economics department, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Elias
authors.initials: E
authors.lastname: Asfaw
authors.affiliation: Department of Health Policy and Management, George Washington University, Washington DC, USA; Management Sciences for Health, Arlington VA, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lopert
authors.affiliation: Department of Economics & Related Studies and Centre for Health Economics, University of York, UK.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Culyer
authors.affiliation: Global Development Program, Bill & Melinda Gates Foundation, Seattle, USA.
authors.forename: Damian G
authors.initials: DG
authors.lastname: Walker
mesh_terms: D057191:Capacity Building; D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000379:methods*; D003657:Decision Making; D003906:Developing Countries; D014943:Global Health; D006291:Health Policy; D006801:Humans; D035501:Uncertainty