2Generalizability of cost-utility analyses across countries and settings

All societies have limited resources, so decisions have to be made about which public health interventions should be provided. A major tool used for prioritisation is cost-utility analysis (CUA) where the outcomes are measured in terms of Disability Adjusted Life Years (DALYs) prevented. Collecting data and building models to calculate the ratio of net costs (i.e.: intervention costs less treatment costs averted due to decreases in morbidity and mortality) to outcomes (CUR) is complex and time consuming. Therefore, there is a great appeal in using CUA calculations that have already been published in other countries. This paper points out the many limitations and inaccuracies caused by generalizing results from CUAs across different countries. However, if time constraints are pressing then first-order estimates of results could be presented after adjustments for the major drivers of the CUR, such as incidence rates, intervention costs and averted treatment costs.