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Eastern Mediterranean Regional Office, World Health Organization Dr. Hossein Salehi May 20-24, 2007 Alexandria, Egypt

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CAPACITY DEVELOPMENT WORKSHOP ON HEALTH SYSTEM DEVELOPMENT FOR REGIONAL COUNTRY OFFICE STAFF Tools for Policy Analysis: Cost Effectiveness Analysis Eastern Mediterranean Regional Office, World Health Organization Dr. Hossein Salehi May 20-24, 2007 Alexandria, Egypt

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slide1

CAPACITY DEVELOPMENT WORKSHOP ON HEALTH SYSTEM DEVELOPMENT FOR REGIONAL COUNTRY OFFICE STAFFTools for Policy Analysis: Cost Effectiveness Analysis

Eastern Mediterranean Regional Office,

World Health Organization

Dr. Hossein Salehi

May 20-24, 2007

Alexandria, Egypt

introduction concept of cost
Introduction; Concept of cost
  • Cost:
    • Accounting cost
    • Economic cost (value of foregone resources)
slide3
Project A; MRI
  • Annual cost $1,000,000
  • Annual Benefit 1,000 DALY averted
  • Project B; Immunization for HB
  • Annual cost $1,000.000
  • Annual Benefit 1,600 DALY averted
  • Project C;(best alternative)
  • Annual cost $1,000,000
  • Annual Benefit 1,800 DALY averted
introduction concept of cost cont
Introduction; Concept of cost; cont

Opportunity cost

“opportunity cost is the value of the best forgone alternative”

introduction concept of cost cont5
Introduction; Concept of cost, cont
  • Who bear(s) the cost?
    • Individual (private) cost
    • Implementing agency cost (public cost)
    • Society (Social Cost) vs. Private cost
why costing
Why costing?
  • Budgeting
  • Provider payment
    • Fee-for-Services
    • Capitation
  • Efficiency
    • Providers
    • Interventions
intervention cost
Intervention cost
  • Intervention cost
    • Cost-Benefit Analysis (CBA)
    • Cost-Effectiveness Analysis (CEA)
      • Generalized Cost-Effectiveness Analysis (GCEA)
who gcea
WHO-GCEA
  • Attention to current inefficiencies in the allocation of resources
  • Context-specific CEA is too demanding for most countries
  • There are no international guideline for CEA
cea cost benefit ratio
CEA; Cost-Benefit ratio

Cost

a1

c

h

O

Health benefits (DALYs averted)

slide10

Cost

a1

C1

a2

C2

h

O

Health benefits (DALYs averted)

`

slide11

a4

c4

a3

b3

a2

a1

c3

b2

b1

c2

c1

slide12

a4

c4

a3

b3

a2

a1

c3

b2

b1

c2

c1

league table
League Table

League Table

who choice project
WHO CHOICE Project
  • Prepared for 14 sub-regions: WHO political groupings and mortality strata
  • All results on www.who.int/choice
  • Country contextualization tool currently being finalized after tests in Thailand, Estonia, Sri Lanka (mental health), Ghana, Mexico
maternal and neonatal
Maternal and neonatal
  • Referral care level
  • Treatment of severe pre-eclampsia/eclampsia*
  • Antibiotics for pre-term prelabour rupture of membranes (pPROM)*
  • Antenatal steroids for pre-term births*
  • Management of obstructed labour, breech & fetal distress (OL)*
  • Management of severe post-partum haemorrhage (PPH)*
  • Management of maternal sepsis*
  • Emergency neonatal care (ENC) combination of 15-18
  • Management of very low birth weight babies (vLBW)*
  • Management of severe neonatal infections*
  • Management of severe neonatal asphyxia*
  • Management of neonatal jaundice*

Primary-level care including outreach

Selected antenatal care interventions (ANC) combination of 1-4

  • Tetanus toxoid (TT)
  • Screening for pre-eclampsia
  • Screening & treatment of asymptomatic bacteruria
  • Screening & treatment of syphilis

Skilled maternal and immediate newborn care (SMNC) combination of 5 -8

  • Normal delivery by skilled attendant
  • Active management of the third stage of labour
  • Initial management of post-partum haemorrhage (PPH)
  • Neonatal resuscitation
  • Community-based interventions
  • Community newborn care package combination of 19-20
  • Support for breastfeeding mothers
  • Support for low birth weight babies
  • Community-based case management for neonatal pneumonia
slide18

Mgmt of Post partum haemorrhage and shock 95%

Antibiotics for pPROM 95%

Mgmt of maternal sepsis 95%

Antenatal steroids

Mgmt of obstructed labour 95%

Emergency newborn care 95%

Pre-eclampsia/ eclampsia 95%

SMNC 95%

Other ANC 95%

Tetanus 95%

Breastfeeding and

care for LBW 95%

Results for Afr-E region

Community-based

Mgmt of pneumonia (95%)

Community mgmt of

pneumonia 95%

results for sear d region

Antenatal steroids95%

Antibiotics for pPROM 95%

Mgmt of obstructed labour 95%

Screening for syphilis 95%

ENC 95%

Maternal sepsis 95%

Resuscitation and referral care for eclampsia 95%

Mgmt of PPH 95%

Community mgmt of pneumonia 95%

Eclampsia and screening for bacteruria 95%

Normal delivery by skilled attendant 95%

LBW95%

Breastfeeding 95%

Tetanus 95%

Tetanus 80%

Breastfeeding 80%

Breastfeeding 50%

Results for Sear-D region

Results for Sear-D region

issues in gcea
Issues in GCEA
  • Estimating cost
  • Estimating health benefits
  • Discounting
  • Uncertainty
  • Ethical issues
  • Equity
ethical issues in cea
Ethical Issues in CEA
  • How should states of health and disability be evaluated?
    • Whose valuation?
    • Is value of a year of life depends on one’s age?
    • socioeconomic status,…?
    • Should health benefits be discounted?
  • How distribution of benefits be considered?
    • What priority should be given to sickest or worst off?
    • Large benefits to a few vs. small benefits to a large group. Which one? (Rule of rescue)
    • Fair chance or best outcome?
slide25

CAPACITY DEVELOPMENT WORKSHOP ON HEALTH SYSTEM DEVELOPMENT FOR REGIONAL COUNTRY OFFICE STAFFTools for Policy Analysis: Cost Effectiveness Analysis

Eastern Mediterranean Regional Office,

World Health Organization

Dr. Hossein Salehi

May 20-24, 2007

Alexandria, Egypt

slide26

Cost-EffectivenessThe case:You have $10,000,000. What project(s) will you select for implementation. Please consider cost-effectiveness, health conditions, ethical issue, equity,…

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