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

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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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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


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Introduction; Concept of cost

  • Cost:

    • Accounting cost

    • Economic cost (value of foregone resources)


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  • 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


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Introduction; Concept of cost; cont

Opportunity cost

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


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Introduction; Concept of cost, cont

  • Who bear(s) the cost?

    • Individual (private) cost

    • Implementing agency cost (public cost)

    • Society (Social Cost) vs. Private cost


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Why costing?

  • Budgeting

  • Provider payment

    • Fee-for-Services

    • Capitation

  • Efficiency

    • Providers

    • Interventions


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Intervention cost

  • Intervention cost

    • Cost-Benefit Analysis (CBA)

    • Cost-Effectiveness Analysis (CEA)

      • Generalized Cost-Effectiveness Analysis (GCEA)


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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


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CEA; Cost-Benefit ratio

Cost

a1

c

h

O

Health benefits (DALYs averted)


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Cost

a1

C1

a2

C2

h

O

Health benefits (DALYs averted)

`


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a4

c4

a3

b3

a2

a1

c3

b2

b1

c2

c1


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a4

c4

a3

b3

a2

a1

c3

b2

b1

c2

c1


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League Table

League Table


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League Table


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League Table


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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


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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


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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%


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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


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Issues in GCEA

  • Estimating cost

  • Estimating health benefits

  • Discounting

  • Uncertainty

  • Ethical issues

  • Equity


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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?


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Which ?


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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


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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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