Cost-effectiveness Of Techniques Research Articles

Fitting nutrition into the medical model: the role of decision analytic cost-effectiveness techniques

Physicians are accustomed to making decisions based on information regarding the prevalence of disease, symptoms, physical signs, laboratory test results, and the risks and benefits of alternative treatments. If nutritional assessment and therapeutics are to become more common components of medical practice, significant barriers in each of these areas must be overcome. Even rudimentary dietary assessment is often missing from physician education. Dietary assessment tools that are readily available and that have demonstrated usefulness are largely unknown. In addition, many nutritional interventions have not been formally investigated in randomized, controlled trials, and thus their cost-effectiveness remains unknown. We present one approach to these issues by discussing the construction of a decision model examining strategies for vitamin D and calcium screening. The application of medical decision making techniques to problems in clinical nutrition illustrates how findings from research studies may be used to determine the risks, benefits and costs of alternative population based health related nutrition policies which can then be applied by physicians in their daily interactions with patients.

Cost-effective applications in space transportation decision support systems

Low cost space transportation is essential to assure proper expansion of the utilization of space and to maintain the required ground and space-based logistical support. This paper examines how a space transportation decision support system could be built and, in particular, how cost-effectiveness techniques and analysis routines would be integrated into this system. The objective is to provide a computerized decision support system that allows the user to configure and evaluate space transportation architectures with respect to cost, schedule and technical parameters. This system would be highly interactive allowing the user to evaluate and compare numerous space transportation architectures against the same and changing evaluation criteria.

Evaluating Population Programs: International Experience with Cost-Effectiveness Analysis and Cost-Benefit Analysis.

This book examines cost-benefit (CBA) and cost-effective analysis (CEA) of the planning and evaluation of population and policy programs particularly in Africa Asia and Latin America. With the general reduction of financial resources throughout the world there is now increasing emphasis on the financial accountability and economic justification for such programs. There are several unsettled questions regarding the application of CBA/CEA to population planning activities. For instance there is no completely satisfactory practical way to measure the impact or outputs of population planning programs. During the past decade there has been extensive work on measuring the fertility impact of family planning programs. The basic question on which there is as yet no general consensus is how much of an observed fertility change should be credited to program efforts as opposed to non-program factors. Input and cost measures raise a series of difficult conceptual and practical issues. The basic input variables are well defined. They include the manpower cost and the cost of supplies facilities and equipment. Problems arise where costs are joint in multi-purpose programs; where the allocation of current costs differs from the timing of their associated outputs; where sources of funds are pooled; where the assignment of values to imported items is based on a system of dual exchange rates; and where actual expenditures are not based on budget allocations. This volume contains 2 parts. The 1st is mainly concerned with methodological and conceptual issues such as the CBA/CEA techniques and their application in the population field or criticism of CBA applications to manpower and population policies. A practical question is whether the application of CBA is appropriate at all levels of program development and how often the exercise should be repeated. A number of authors feel that although attention must be given to CBA on the development planning level more attention should be devoted to the development of cost-effectiveness techniques as a guide for the effective and efficient operation of population planning programs. The focus in CEA is more on program strategy and operation and the findings are of greater relevance to program managers. While the 1st part of this volume is devoted to theoretical and methodological aspects of cost-benefit and cost-effectiveness analysis the 2nd part examines its application to family planning programs. The problems of application revealed include issues of measurement cost estimation and standardization of output measures. It is argued that it is the dialogue between those concerned with conceptual development and those involved with application that provides the unique contribution of this volume.

Theoretical and empirical issues in benefit identification, measurement and valuation related to parasitic disease control in poor countries

Considerable resources have been allocated over the years to parasitic disease eradication or control, e.g. malaria and schistosomiasis. Decision-makers in recent years have increasingly appealed to economists seeking an economic justification in order to continue or renew support for such programmatic efforts. Often economists when facing such an analytical task have employed benefit-cost or cost-effectiveness analytical techniques. This paper reviews the theoretical and empirical rationale employed in the conduct of such studies, focusing particularly on the benefits or impact indicators used. The review identifies many problems encountered in identifying benefits, and then measuring and valuing them.

Selective primary health care: Is efficient sufficient?

Developing countries are increasingly using economic evaluation methods to assess and plan their health services. Inappropriate application of these methods may lead to serious errors in developing primary health care strategies. In ‘Selective Primary Health Care’, Julia Walsh and Kenneth Warren present a logical approach to health planning based on cost-effectiveness techniques. Their paper is a timely example of the risks of using simple technical criteria to plan solutions to complex public health problems. Cost-effectiveness is not a sufficient criterion for planning primary health care. Related issues are discussed in these comments. As an alternative, a multiple-objective approach is suggested.

Situational Normativism: A descriptive-normative approach to decision making and policy sciences

With the objective of improving policy making, efforts have recently intensified to integrate behavioral sciences, cost-effectiveness analysis, and related disciplines into an evolving field that has been termed “policy sciences.” After reviewing some aspects of policy sciences, the paper discusses an approach, called situational normativism, by which the components of policy sciences may be put to work effectively on real decision problems. The approach is situational in that each problem must be approached individually, but the methodology can be viewed as a general heuristic. Thus, situational normativism involves a synthesis of descriptive (behavioral) and normative approaches. One begins with a descriptive model of a real world decision situation in terms of the participants, their values (objectives, goals) and the decision rules that determine existing outcomes. Then, the analysis becomes normative (and may use mathematical optimizing techniques) in the sense of generating prescriptive alternatives for attaining in a preferred way these same values or a more fundamental set identified during the analysis. The iterative process, including adaptive system redesign, involves a search for a set of means-ends (goals, constraints) relationships within which a search for prescriptive solutions may be undertaken. Change, implementation, and political feasibility are viewed as constraints to be satisfied. Thus, situational normativism provides a framework for the combined use of behavioral knowledge and costeffectiveness techniques for improved policy making.

Application of cost/effectiveness analysis to EDP system selection

A conceptual approach for evaluating and selecting among alternative Electronic Data Processing (EDP) systems proposed to meet a set of EDP user needs has been developed by applying cost-effectiveness methods and techniques to the source selection problem. The report provides a framework that allows the EDP system eveluator to combine the selected relevant system performance measures and the related cost elements to arrive at a rational defendable selection decision.