CAPACITY DEVELOPMENT WORKSHOP ON HEALTH SYSTEM DEVELOPMENT FOR REGIONAL COUNTRY OFFICE STAFF Tools f

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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)
11
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

• 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

• 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

• 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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Results for Afr-E region
Community-based Mgmt of pneumonia (95)
Community mgmt of pneumonia 95
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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 ones 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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Source WHO/EIP
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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
caseYou have 10,000,000. What project(s) will
you select for implementation. Please consider
cost-effectiveness, health conditions, ethical
issue, equity,