Cost-effectiveness Evaluations Of Interventions Research Articles

Effective strategies to improve health worker performance in delivering adolescent-friendly sexual and reproductive health services.

Despite recognition of the important role of health workers in providing adolescent-friendly sexual and reproductive health services (AFSRHS), evidence on strategies for improving performance is limited. This review sought to address: (1) which interventions are used to improve health worker performance in delivering AFSRHS? and (2) how effective are these interventions in improving AFSRHS health worker performance and client outcomes? Building on a 2015 review, a search for literature on 18 previously identified programs was conducted to identify updated literature and data relevant to this review. Data was systematically extracted and analyzed. Due to the parent review's eligibility criteria, all programs included health worker training. Otherwise, supervision was the most frequently reported intervention used (n=10). Components and methods related to quality of trainings and supervision varied considerably in program reports. Nearly half of programs described employing processes to ensure availability of basic medicines and supplies (n=7). Other interventions (policies, standards, and job descriptions [n=5]; refresher trainings [n=5]; job aids or other reference material [n=3]) were less commonly reported to have been employed. No discernible patterns emerged in the relationship between interventions and outcomes of interest. Multi-faceted complementary strategies are recommended to improve health worker performance to deliver AFSRHS; however, this was uncommonly reported in the programs that we reviewed. Effectiveness and cost-effectiveness evaluations of interventions and intervention packages are needed to guide efficient use of limited resources to enhance health worker capacity to deliver AFSRHS. In the interim, programs should be developed and implemented based on available existing evidence on improving health worker performance within and outside adolescent health. This review is the first to examine the interventions commonly used to improve health worker performance in delivering AFSRHS. The findings indicate a need for additional effectiveness and cost-effectiveness evaluations of such interventions. In the meantime, existing evidence on improving health worker performance within and outside adolescent health must be integrated more thoughtfully into program planning and implementation.

PCN92 - The Indirect Costs of Breast Cancer in The Slovak Republic

Breast cancer (BC) is the most common cancer (2009: standardised incidence ratio 62.35/ 100,000; accounting 17.72% of all new cases of cancer in females) and the most common mortality for cancer among women in Slovakia (2015: standardised mortality ratio 17.51/100,000; accounting 17.47% of all causes of cancer death in females). This cost study aims to estimate indirect costs of BC in Slovakia in 2015. To estimate indirect costs for BC the Human Capital method was used. The study was performed from the social perspective. Data were analysed from publicly available outputs of the database systems of Statistical Office of the Slovak Republic, Social Insurance Agency and The Ministry of Labour, Social Affairs and Family of the Slovak Republic. Data not publicly available were obtained from health authorities on request. In calculation parameters included sickness benefits during temporary incapacity, productivity loss, loss of taxes and contributions, invalidity pension (IP) and financial benefits for severely disabled person (FBSDP). Whereas some data were not available the outcome of the study is presented as a range of possible results. Total indirect costs of BC were estimated in the range from € 99.76 mil. to € 157.23 mil. The major financial burden were caused by expenditures on IP (proportion 82.90%-88.79%) and the minor costs were assigned to FBSDP (proportion 0.05%-0.39%). So far, no published study has estimated the indirect cost of BC in Slovakia. According to our findings BC can contribute substantially to total financial burden of BC. Our study provides the first estimate of the burden of disease and can serve as a baseline for cost of illness studies and cost-effectiveness evaluations of interventions used in BC.