Economic evaluation of health program.pptx

The comparative analysis of alternative courses of action in terms of both their costs and consequences

1. Economic evaluation of health program

2. Outline

3. The comparative analysis of alternative courses of action in terms of both their costs and consequences Cost A Cost B Economic Evaluation

4. Importance of economic evaluation

5. Are both costs (inputs) & consequences (outputs) of the alternatives examined? Economic evaluation No No Yes Examines only consequences Examines only costs Partial Evaluation Outcome Description Partial Evaluation Cost Description Partial Evaluation Cost Outcome description Yes Partial Evaluation Efficacy or Effectiveness Evaluation Partial Evaluation Cost Analysis Full Economic Evaluation Cost Benefit Cost Effectiveness Cost Utility Is there a comparison of two or more alternatives?

6. Types of economic evaluation

7. Cost Minimisation analysis

8. Cost Effectiveness Analysis (CEA)

9. Cost Effectiveness Analysis (CEA)

10. Cost Effectiveness Analysis (CEA)

11. Cost effectiveness Analysis(CEA) More effective Less Cost More Cost Less Effective New Intervention Cost Effective Old Intervention Dominates

12. Cost effectiveness Analysis(CEA).. More effective Less Cost More Cost Less Effective Accept New Intervention Accept New Intervention Reject New Intervention Reject New Intervention Reject New Intervention Willingness To Pay Threshold

13. Advantages Easier to interpret as it uses familiar clinical end points Disadvantage Difficult to make inter-disease comparisons It is a challenge to define the most appropriate effectiveness end-point Cost effectiveness Analysis(CEA)..

14. Cost utility Analysis (CUA)

15. Cost benefit analysis

16. Cost benefit Analysis.. Summary measures Benefit-cost ratio Net benefit

17. Cost Benefit Analysis (CBA)..

18. Type Outcome can be measured by Cost effectiveness analysis Clinical end points Mortality Years of life gained Deaths avoided Condition specific outcome measures Cost utility analysis QALYs/DALYs Cost benefit analysis CBR (Human capital) Net benefit Types of economic evaluation..

19. Various types of costs

20. Opportunity cost 20 The value of best alternative foregone To choose the healthcare service where benefits outweigh opportunity cost

21. Number of patients (A) Total Fixed cost (B) Total Variable cost (C) Total cost (B+C) 10 100,000 50,000 150,000 20 100,000 80,000 1,80,000 30 100,000 100,000 200,000 40 100,000 110,000 210,000 50 100,000 210,000 310,000 60 100,000 250,000 350,000 70 100,000 350,000 4,50,000 80 100,000 640,000 740,000 Fixed Vs Variable cost

22. Types of costs 22

23. Types of costs

24. Benefits 24

25. Valuation of various costs

26. Human Capital Approach

27. Human capital approach..

28. Measures of health consequences

29. Direct utility assessment

30. Standard Gamble Standard gamble

31. Direct utility assessment.. Time trade-off A simpler alternative to standard gamble Asking a respondent to consider the relative amounts of time they would be willing to trade in order to survive in various health states

32. EQ-5D

33. Evaluation of immunisation program

34. Framing the analysis

35. Costing Identify which costs to include Costs of health sector Inputs to be assessed a. Supplies b. Distribution system: Storage and cold chain c. Waste management d. Personnel e. Disease surveillance f. Other costs

36. Costing Costs for patients and their families, including lost productivity When to measure resource use a.Ex -post b.Ex -ante Data regarding resource usage can be obtained from a.RCT b.Medical records c. Questionnaires given to physicians, patients or their carers Costing

37. Assessing the effects of vaccination programme

38. Interpretation of data

39. Challenges Lack of well-established national level agencies National Institute for Health and Clinical Excellence (NICE) – England No specialty courses in field of health economics Lack of trained human resource & limited awareness among policy makers Lack of government funding for economic evaluation studies in India

40. Way forward

41. References WHO guide for standardization of economic evaluations of immunization programs http://whqlibdoc.who.int/hq/2008/WHO_IVB_08.14_eng.pdf Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes . 4 th edition. New York: Oxford university press; 2015. Gray, A. Economic Evaluation in Dawes, et al. Ed. Evidence Based Practice: A primer for health care professionals. 2001 Pandit A. Health economic evaluation – Methods and techniques. IOSR – JEF.2016;7(1):1-9.

42. References.. 5.Guinness L, Wiseman V. Introduction to health economics . 2 nd edition. England: Open university press;2011. 6.Sathe P V, Doke P P . Epidemiology and management for health care.5 th edition. Mumbai: Vora medical publications;2018.p284-88. 7.Health Technology Assessment in India: A Manual. Department of Health Research. Ministry of Health and family welfare. GoI : New Delhi;2018. 8.Russell LB. Opportunity costs in modern medicine. Health affairs. 1992;11(2):162-9. 9. Kadri A M.IAPSM’s Textbook of Community Medicine. New Delhi: Jaypee brothers medical publishers (P) Ltd;2019.p1026-28

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