Economic Evaluation Of Health Interventions Research Articles

Cost-benefit analysis of Intensive Care Unit with Activity-Based Costing approach in the era COVID-19 pandemic: A case study from Iran.

Providing intensive care to acute patients is a vital part of health systems. However, the high cost of Intensive Care Units (ICU) has limited their development, especially in low-income countries. Due to the increasing need for intensive care and limited resources, ICU cost management is important. This study aimed to analyze the cost-benefit of ICU during COVID-19 in Tehran, Iran. This cross-sectional study is an economic evaluation of health interventions. The study was conducted in the COVID-19 dedicated ICU, from the provider's point of view and within one-year horizon. Costs were calculated using a top-down approach and the Activity-Based Costing technique. Benefits were extracted from the hospital's HIS system. Benefit Cost ratio (BCR) and Net Present Value (NPV) indexes were used for cost-benefit analysis (CBA). A sensitivity analysis was performed to evaluate the dependence of the CBA results on the uncertainties in the cost data. Analysis was performed with Excel and STATA software. The studied ICU had 43 personnel, 14 active beds, a 77% bed occupancy rate, and 3959 occupied bed days. The total costs were $2,372,125.46 USD, of which 70.3% were direct costs. The highest direct cost was related to human resources. The total net income was $1,213,314.13 USD. NPV and BCR were obtained as $-1,158,811.32 USD and 0.511 respectively. Despite operating with a relatively high capacity, ICU has had high losses during the COVID-19. Proper management and re-planning in the structure of human resources is recommended due to its importance in the hospital economy, provision of resources based on needs assessment, improvement of drugs management, reduction of insurance deductions in order to reduce costs and improve ICU productivity.

Economic Evaluation of Health Interventions: A Critical Review.

Economic evaluation is used for the optimal allocation of resources in the health sector. While a large number of economic evaluation studies have been conducted, there is less critical review of these studies. We critically examined the economic evaluation studies of preventive health interventions. The study was carried out using critical review method. Seven databases (i.e., PubMed, Cochrane Database of Systematic Reviews, Web of Science, Science Direct, Scopus, Springer Link, and Elsevier) were searched to find articles on economic evaluation of health interventions published from 1985 to 2018. In addition, the references of retrieved studies were hand screened for articles that were not indexed in these databases. Finally, 206 articles, including 33 cost- benefit analysis, 146 cost- effectiveness analysis, and 27 cost-utility analysis were included in this study. These studies were critically evaluated using a checklist of 11 criteria. Only 20% of the studies met all the methodological criteria of health economic evaluation. The cost perspective, costs type, cost data source, and cost measurement were not explained and discussed in 17%, 20%, 5%, and 33% of studies respectively. Outcome data sources and outcome valuation method were only mentioned in 53% and 69% of studies. The sensitivity analysis and results' generalizability were not reported in 16% and 46% of studies. The quality of economic evaluation studies is low, and it can be misleading if resource allocation decisions are made using this evidence. Authors should use valid protocols to conduct and report economic evaluation studies, and journals' editors should use valid checklists to evaluate these articles.

Methodological issues for the economic evaluation of health interventions: a concise state of the art

This paper presents a preliminary report of the Italian Society of Medical Statistics and Clinical Epidemiology (SISMEC) working group called SiPrEMAS (Evidence Synthesis and Decision Modelling in Health) collating some topics addressed throughout the first two years of collaboration. It contains a rapid overview of the principal methods used for the economic evaluation of health interventions. Special focus is given to the process of assembling and pooling the available evidence, modeling methods, the analysis of uncertainty (structural and on parameters), cost analysis and cost consequences analysis. This paper intends to stimulate the discussion among different professionals involved in the decision making process at national level, trying to (re)bridge the gap between decision makers and researchers.

MO845EUROQOL EQ-5D-3L IN DIALYSIS POPULATION IN COLOMBIA

Abstract Background and Aims The EuroQol-5D (EQ-5D-3L) is a generic questionnaire to evaluate the quality of life related to health, and simultaneously facilitates the obtaining of preference values (utilities) In the economic evaluation of health interventions. Quality-adjusted life year (QALY) is a commonly used metric. Our objective is to evaluate the quality of life (QoL) and obtaining of utilities according the dialytic treatment. Method This was an observational, multicentre cross-sectional study. Prevalent patients on dialysis for at least 90 days, older than 18, at the Baxter Renal Care Services Colombia were included between August 2, 2019, to December 11, 2020. Socio-demographic and clinical characteristics of all patients were summarized descriptively, additionally, all categorical variables were compared with Pearson’s χ2 test or Fisher’s exact test and continuous variables were analysed with Student’s t-test or Mann Whitney U test. The difference in the QoL by domains will be evaluated using Pearson's χ2 test or Fisher’s exact test. The EQ VAS provides a quantitative measure of the patient’s perception of their overall health. Results A total 254 patients were evaluated, the median age was 55 years, 55% were men. At enrolment the median dialysis vintage 3.2 years, and 63% were in peritoneal dialysis treatment (Table 1). We did not find differences in the proportions by dialysis treatment when exploring each of the 5 dimensions of the QoL (Table 2). We observed that the patient´s perception of their overall health was similar median EQ VAS score 80 in HD and EQ VAS score 80 in PD (Figure 1). We did not find statistically significant differences in health status 11111, which represents not having problems in any dimension 46.8% versus 45.6%, HD and PD respectively, p-value= 0.855. Conclusion The quality of life reported by the patients and health status in haemodialysis was similar to peritoneal dialysis.

A Comparison of the SF-6Dv2 and SF-6D UK Utility Values in a Mixed Patient and Healthy Population.

BackgroundThis paper describes the first evaluation of the construct validity and performance of the newly developed preference-based measure of health, the SF-6D version 2 (SF-6Dv2).MethodUtilising data from the Multi-Instrument Comparison (MIC) project (n = 7932), we explored the descriptive differences in utility values between the SF-6Dv2 and the SF-6D and evaluated the known group validity of both measures by testing the statistical significance of differences in utility values and calculating the effect sizes across known groups. The convergent validity of the SF-6Dv2 was explored by examining whether the SF-6Dv2 is related to alternative validated measures, including the EQ-5D-5L and AQoL-8D.ResultsDifferences between the utility values of the SF-6Dv2 and SF-6D were evident; utilities were generally lower for the SF-6Dv2, with larger standard deviations resulting in larger absolute differences between groups. The SF-6Dv2 performed well in terms of known-group validity and successfully distinguished disease severity and between the disease and healthy groups, outperforming the SF-6D in some but not all groups. Convergent validity analyses indicated strong associations between the SF-6Dv2 and the SF-6D, EQ-5D-5L and AQoL-8D utilities.ConclusionsThe psychometric performance of the SF-6Dv2 is favourable with respect to known group validity and convergent validity, but does not seem to have improved, compared with the SF-6D. However, the new method of valuation has had a substantial impact on the size of absolute differences in utility values, which could impact quality-adjusted life-year results. The economic evaluation of health interventions may therefore be influenced by the choice of the SF-6Dv2 over the SF-6D.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40273-021-01033-6.

Health, financial, and education gains of investing in preventive chemotherapy for schistosomiasis, soil-transmitted helminthiases, and lymphatic filariasis in Madagascar: A modeling study.

BackgroundNeglected tropical diseases (NTDs) account for a large disease burden in sub-Saharan Africa. While the general cost-effectiveness of NTD interventions to improve health outcomes has been assessed, few studies have also accounted for the financial and education gains of investing in NTD control.MethodsWe built on extended cost-effectiveness analysis (ECEA) methods to assess the health gains (e.g. infections, disability-adjusted life years or DALYs averted), household financial gains (out-of-pocket expenditures averted), and education gains (cases of school absenteeism averted) for five NTD interventions that the government of Madagascar aims to roll out nationally. The five NTDs considered were schistosomiasis, lymphatic filariasis, and three soil-transmitted helminthiases (Ascaris lumbricoides, Trichuris trichiura, and hookworm infections).ResultsThe estimated incremental cost-effectiveness for the roll-out of preventive chemotherapy for all NTDs jointly was USD125 per DALY averted (95% uncertainty range: 65–231), and its benefit-cost ratio could vary between 5 and 31. Our analysis estimated that, per dollar spent, schistosomiasis preventive chemotherapy, in particular, could avert a large number of infections (176,000 infections averted per $100,000 spent), DALYs (2,000 averted per $100,000 spent), and cases of school absenteeism (27,000 school years gained per $100,000 spent).ConclusionThis analysis incorporates financial and education gains into the economic evaluation of health interventions, and therefore provides information about the efficiency of attainment of three Sustainable Development Goals (SDGs). Our findings reveal how the national scale-up of NTD control in Madagascar can help address health (SDG3), economic (SDG1), and education (SDG4) goals. This study further highlights the potentially large societal benefits of investing in NTD control in low-resource settings.

Cost-effectiveness analysis for decision making in health care-concept, relevance and methodological challenges

With continuous rise in health spending among countries, the need to make use of limited resources in health systems has become crucial. Health policy makers in countries strive to identify the interventions which can contribute to improving health outcomes. Techniques of economic evaluation, especially cost effectiveness analysis (CEA) have been widely applied in health sector to identify interventions that are more effective in terms of resources utilization. An understanding of CEA will not only help policy makers to take appropriate decisions in health sector but also in judicious spending of scarce resources. However, CEA studies have been flaunted with series of methodological challenges and practicability issues. This paper provides an introduction to CEA as one of the techniques of economic evaluation of health interventions and its relevance in making decisions in health sector. The paper also discusses some of the practical issues that arise while doing a CEA study in the health sector.

A Checklist for the Conduct, Reporting, and Appraisal of Microcosting Studies in Health Care: Protocol Development.

BackgroundMicrocosting is a cost estimation method that requires the collection of detailed data on resources utilized, and the unit costs of those resources in order to identify actual resource use and economic costs. Microcosting findings reflect the true costs to health care systems and to society, and are able to provide transparent and consistent estimates. Many economic evaluations in health and medicine use charges, prices, or payments as a proxy for cost. However, using charges, prices, or payments rather than the true costs of resources can result in inaccurate estimates. There is currently no existing checklist or guideline for the conduct, reporting, or appraisal of microcosting studies in health care interventions.ObjectiveThe aim of this study is to create a checklist and guideline for the conduct, reporting, and appraisal of microcosting studies in health care interventions.MethodsAppropriate potential domains and items will be identified through (1) a systematic review of all published microcosting studies of health and medical interventions, strategies, and programs; (2) review of published checklists and guidelines for economic evaluations of health interventions, and selection of items relevant for microcosting studies; and (3) theoretical analysis of economic concepts relevant for microcosting. Item selection, formulation, and reduction will be conducted by the research team in order to develop an initial pool of items for evaluation by an expert panel comprising individuals with expertise in microcosting and economic evaluation of health interventions. A modified Delphi process will be conducted to achieve consensus on the checklist. A pilot test will be conducted on a selection of the articles selected for the previous systematic review of published microcosting studies.ResultsThe project is currently in progress.ConclusionsStandardization of the methods used to conduct, report or appraise microcosting studies will enhance the consistency, transparency, and comparability of future microcosting studies. This will be the first checklist for microcosting studies to accomplish these goals and will be a timely and important contribution to the health economic and health policy literature. In addition to its usefulness to health economists and researchers, it will also benefit journal editors and decision-makers who require accurate cost estimates to deliver health care.

Controversial Issues in Economic Evaluation (III): health Care Interventions in Special Situations

The development of the economic evaluation of health care interventions has become a support tool in making decisions on pricing and reimbursement of new health interventions. The increasingly extensive application of these techniques has led to the identification of particular situations in which, for various reasons, it may be reasonable to take into account special considerations when applying the general principles of economic evaluation. In this article, which closes a series of three, we will discuss, using the Metaplan technique, about the economic evaluation of health interventions in special situations such as rare diseases and end of life treatments, as well as consideration of externalities in assessments, finally pointing out some research areas to solve the main problems identified in these fields.

Economic evaluation of Community Level Interventions for Pre-eclampsia (CLIP) in South Asian and African countries: a study protocol.

BackgroundGlobally, hypertensive disorders of pregnancy, particularly pre-eclampsia and eclampsia, are the leading cause of maternal and neonatal mortality, and impose substantial burdens on the families of pregnant women, their communities, and healthcare systems. The Community Level Interventions for Pre-eclampsia (CLIP) Trial evaluates a package of care applied at both community and primary health centres to reduce maternal and perinatal disabilities and deaths resulting from the failure to identify and manage pre-eclampsia at the community level. Economic evaluation of health interventions can play a pivotal role in priority setting and inform policy decisions for scale-up. At present, there is a paucity of published literature on the methodology of economic evaluation of large, multi-country, community-based interventions in the area of maternal and perinatal health. This study protocol describes the application of methodology for economic evaluation of the CLIP in South Asia and Africa.MethodsA mixed-design approach i.e. cost-effectiveness analysis (CEA) and qualitative thematic analysis will be used alongside the trial to prospectively evaluate the economic impact of CLIP from a societal perspective. Data on health resource utilization, costs, and pregnancy outcomes will be collected through structured questionnaires embedded into the pregnancy surveillance, cross-sectional survey and budgetary reviews. Qualitative data will be collected through focus groups (FGs) with pregnant women, household male-decision makers, care providers, and district level health decision makers. The incremental cost-effectiveness ratio will be calculated for healthcare system and societal perspectives, taking into account the country-specific model inputs (costs and outcome) from the CLIP Trial. Emerging themes from FGs will inform the design of the model, and help to interpret findings of the CEA.DiscussionThe World Health Organization (WHO) strongly recommends cost-effective interventions as a key aspect of achieving Millennium Development Goal (MDG)-5 (i.e. 75 % reduction in maternal mortality from 1990 levels by 2015). To date, most cost-effectiveness studies in this field have focused specifically on the diagnostic and clinical management of pre-eclampsia, yet rarely on community-based interventions in low-and-middle-income countries (LMICs). This study protocol will be of interest to public health scientists and health economists undertaking community-based trials in the area of maternal and perinatal health, particularly in LMICs.Trial registrationClinicalTrials.gov: NCT01911494

Health gains and financial risk protection afforded by public financing of selected interventions in Ethiopia: an extended cost-effectiveness analysis.

The way in which a government chooses to finance a health intervention can affect the uptake of health interventions and consequently the extent of health gains. In addition to health gains, some policies such as public finance can insure against catastrophic health expenditures. We aimed to evaluate the health and financial risk protection benefits of selected interventions that could be publicly financed by the government of Ethiopia. We used extended cost-effectiveness analysis to assess the health gains (deaths averted) and financial risk protection afforded (cases of poverty averted) by a bundle of nine (among many other) interventions that the Government of Ethiopia aims to make universally available. These nine interventions were measles vaccination, rotavirus vaccination, pneumococcal conjugate vaccination, diarrhoea treatment, malaria treatment, pneumonia treatment, caesarean section surgery, hypertension treatment, and tuberculosis treatment. Our analysis shows that, per dollar spent by the Ethiopian Government, the interventions that avert the most deaths are measles vaccination (367 deaths averted per $100,000 spent), pneumococcal conjugate vaccination (170 deaths averted per $100,000 spent), and caesarean section surgery (141 deaths averted per $100,000 spent). The interventions that avert the most cases of poverty are caesarean section surgery (98 cases averted per $100,000 spent), tuberculosis treatment (96 cases averted per $100,000 spent), and hypertension treatment (84 cases averted per $100,000 spent). Our approach incorporates financial risk protection into the economic evaluation of health interventions and therefore provides information about the efficiency of attainment of both major objectives of a health system: improved health and financial risk protection. One intervention might rank higher on one or both metrics than another, which shows how intervention choice-the selection of a pathway to universal health coverage-might involve weighing up of sometimes competing objectives. This understanding can help policy makers to select interventions to target specific policy goals (ie, improved health or financial risk protection). It is especially relevant for the design and sequencing of universal health coverage to meet the needs of poor populations.

Controversial issues in economic evaluation (I): perspective and costs of Health Care interventions

Economic evaluation of health care interventions has experienced a strong growth over the past decade and is increasingly present as a support tool in the decisions making process on public funding of health services and pricing in European countries. A necessary element using them is that agents that perform economic evaluations have minimum rules with agreement on methodological aspects. Although there are methodological issues in which there is a high degree of consensus, there are others in which there is no such degree of agreement being closest to the normative field or have experienced significant methodological advances in recent years. In this first article of a series of three, we will discuss on the perspective of analysis and assessment of costs in economic evaluation of health interventions using the technique Metaplan. Finally, research lines are proposed to overcome the identified discrepancies.

Cost-Value Analysis of Health Interventions: Introduction and Update on Methods and Preference Data

According to the consensus statement from the International Society for Pharmacoeconomics and Outcomes Research Quality-Adjusted Life-Year (QALY) workshop in Philadelphia in 2007 "concerns for fairness may cause social resource allocation preferences to deviate considerably from the ranking that consideration of costs per QALY would suggest." Salient concerns for fairness include the view that priority should be given to the severely ill over the less severely ill, that people have a right to realize their potential for health even if their capacity to benefit from treatment is moderate, and that everybody has the same right to treatment that averts premature death, even if their health and functional level is less than perfect. Cost-value analysis incorporates these concerns in formal economic evaluation of health interventions and programs and thus has a potential for ranking interventions and programs in a way that is more consistent with societal values. Data on the strength of public concerns for fairness are now sufficient to be useful in formal economic evaluation. The data may, within a context of fair and open deliberations, help societal decision makers to roughly indicate the societal value of a QALY in different circumstances and thus determine a tentative grading of willingness to pay for a QALY.

Item Response Theory Approaches to Harmonization and Research Synthesis.

The need to harmonize different outcome metrics is a common problem in research synthesis and economic evaluation of health interventions and technology. The purpose of this paper is to describe the use of multidimensional item response theory (IRT) to equate different scales which purport to measure the same construct at the item level. We provide an overview of multidimensional item response theory in general and the bi-factor model which is particularly relevant for applications in this area. We show how both the underlying true scores of two or more scales that are intended to measure the same latent variable can be equated and how the item responses from one scale can be used to predict the item responses for a scale that was not administered but are necessary for the purpose of economic evaluations. As an example, we show that a multidimensional IRT model predicts well both the EQ-5D descriptive system and the EQ-5D preference index from SF-12 data which cannot be directly used to perform an economic evaluation. Results based on multidimensional IRT performed well compared to traditional regression methods in this area. A general framework for harmonization of research instruments based on multidimensional IRT is described.

Transforming EQ-5D utilities for use in cost–value analysis of health programs

In a number of jurisdictions there is increasing interest in incorporating concerns for fairness in models for economic evaluation of health interventions. Cost–value analysis is a name for evaluations with such a broader aim. The most widely held concern for fairness is a concern for the worse off, i.e. the idea that severity of illness should count in determining priorities. In economic evaluations of improvements in health-related quality of life this concern may be taken into account by replacing conventional health state utilities with societal values for health states that are characterised by strong upper end compression and decreasing marginal value of utility gains. We review evidence on the strength of concerns for the worse off--measured at the cardinal level--in 15 articles published in peer-reviewed journals in the time period 1978–2010, with reports from altogether 20 individual studies in nine different countries. We report 116 individual observations of paired comparisons of utility improvements with different start levels. Concerns for severity show up quite strongly across countries, sample types and question framings. By means of regression analyses we fit a societal value function to the data that has the property of decreasing marginal value of utility gains. Using the central tendency in the data we present two plausible transformations of EQ-5D utilities into societal values that reflect concerns for the worse off.

Mapping to Obtain EQ-5D Utility Values for Use in NICE Health Technology Assessments

Quality-adjusted life-years (QALYs) are widely used as an outcome for the economic evaluation of health interventions. However, preference-based measures used to obtain health-related utility values to produce QALY estimates are not always included in key clinical studies. Furthermore, organizations responsible for reviewing or producing health technology assessments (HTAs) may have preferred instruments for obtaining utility estimates for QALY calculations. Where data using a preference-based measure or the preferred instrument have not been collected, it may be possible to “map” or “crosswalk” from other measures of health outcomes. The aims of this study were 1) to provide an overview of how mapping is currently used as reported in the published literature and in an HTA policy-making context, specifically at the National Institute for Health and Clinical Excellence in the United Kingdom, and 2) to comment on best current practice on the use of mapping for HTA more generally. The review of the National Institute for Health and Clinical Excellence guidance found that mapping has been used since first established but that reporting of the models used to map has been poor. Recommendations for mapping in HTA include an explicit consideration of the generalizability of the mapping function to the target sample, reporting of standard econometric and statistical tests including the degree of error in the mapping model across subsets of the range of utility values, and validation of the model(s). Mapping can provide a route for linking outcomes data collected in a trial or observational study to the specific preferred instrument for obtaining utility values. In most cases, however, it is still advantageous to directly collect data by using the preferred utility-based instrument and mapping should usually be viewed as a “second-best” solution.

Exploring Model Uncertainty in Economic Evaluation of Health Interventions: The Example of Rotavirus Vaccination in Vietnam

Motivated by observed discrepancies between 2 published studies on the cost-effectiveness of rotavirus vaccination in Vietnam, the authors' objectives were to illustrate a specific, systematic approach to assessing model (structure and process) uncertainty and to quantify explicitly the contributions of different sources of variation in the outputs of different studies that share the same research question. On the basis of a series of working definitions of key model elements, the authors developed 5 alternative computer simulation (state-transition) models of rotavirus disease. They examined how epidemiological outcomes and cost-effectiveness ratios associated with rotavirus vaccination would change as elements of model structure and modeling process were progressively modified. They also explicitly decomposed the relative contributions of different modeling elements to differences in the cost-effectiveness results between the 2 previous analyses motivating the present study. The findings suggest that within the category of a static, deterministic, aggregate-level model, different choices in model structure and process lead to relatively modest differences in the estimated cost-effectiveness of rotavirus vaccination, but that intermediate epidemiologic outcomes vary more substantially depending on the choice of model structure. The authors caution against generalizing the quantitative results in this study beyond the present example but suggest that the approach presented here may serve as a template for other examinations of model uncertainty. As new research questions arise after the introduction of rotavirus vaccination programs, a reevaluation of model uncertainty is likely to be needed.

Economic Evaluation in the US

In this paper we consider the evolving American healthcare landscape and what it means for the use of economic evaluation of health interventions. We emphasise that use of economic evaluation in the US is unlikely to follow the European, Canadian or Australian models, which use cost effectiveness openly and explicitly, given the decentralised manner in which American healthcare is organised, financed and delivered, as well as different political systems and traditions, and cultural expectations and attitudes surrounding healthcare. However, this does not mean that considerations of value are absent. On the contrary, measurement of value remains near the top of the agenda among US policy makers. With a few exceptions, it just isn't playing out explicitly. In the American context, it means in part heightened debate over clinical evidence, and cost sharing. In some cases, payers are also considering economic evaluation more directly in coverage and reimbursement decisions and indirectly for clinical practice guidelines and best practice recommendations. A dramatic shift in policy towards cost effectiveness seems unlikely in the near future. Change will likely come in incremental fashion through experimentation, and perhaps in selected circumstances with public and private leaders willing to take the political risks. Conceivably, more substantial change will occur with a major shift in the political leadership in Washington, DC in the legislative or executive branches, and/or with an economic downturn and severe pressures on federal and state health budgets. However, a more likely outcome is the ongoing indirect use of cost-effectiveness information.

Making choices in health: who guide to cost-effectiveness analysis

Part One: METHODS FOR GENERALIZED COST-EFFECTIVENESS -- Ch. 1. What is generalized cost-effectiveness analysis? -- Ch. 2. Undertaking a study using GCEA -- Ch. 3. Estimating costs -- Ch. 4. Estimating health effects -- Ch. 5. Discounting -- Ch. 6. Uncertainty in cost-effectiveness analysis -- Ch. 7. Policy uses of generalized CEA -- Ch. 8. Reporting CEA results -- Ch. 9. Summary of recommendations -- Annex A. WHO-CHOICE activities on generalized cost-effectiveness analysis -- Annex B. Draft list of intervention clusters for evaluation by WHO-CHOICE -- Annex C. An illustration of the types of costs included in a selection of intervention activities at central levels -- Annex D. Interpreting international dollars -- Annex E. DALYs to measure burden of dollars -- Annex F. Measuring intervention benefit at the population level -- Annex G. Epidemiological subregions as applied in WHO generalized CEA -- Part Two: BACKGROUND PAPERS AND APPLICATIONS -- Ch. 1. Development of WHO guidelines on generalized cost-effectiveness analysis -- Ch. 2. PopMod: a longitudinal population model with two interacting disease states -- Ch. 3. Programme costs in the economic evaluation of health interventions -- Ch. 4. Econometric estimation of country-specific hospital costs -- Ch. 5. Stochastic league tables: communicating cost-effectiveness results to decision-makers -- Ch. 6. Uncertainty in cost-effectiveness analysis: probabilistic uncertainty analysis and stochastic league tables -- Ch. 7. Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk -- Ch. 8. Generalized cost-effectiveness analysis: an aid to decision making in health -- Ch. 9. Ethical issues in the use of cost effectiveness analysis for the prioritization of health care resources.

Programme costs in the economic evaluation of health interventions.

Estimating the costs of health interventions is important to policy-makers for a number of reasons including the fact that the results can be used as a component in the assessment and improvement of their health system performance. Costs can, for example, be used to assess if scarce resources are being used efficiently or whether there is scope to reallocate them in a way that would lead to improvements in population health. As part of its WHO-CHOICE project, WHO has been developing a database on the overall costs of health interventions in different parts of the world as an input to discussions about priority setting.Programme costs, defined as costs incurred at the administrative levels outside the point of delivery of health care to beneficiaries, may comprise an important component of total costs. Cost-effectiveness analysis has sometimes omitted them if the main focus has been on personal curative interventions or on the costs of making small changes within the existing administrative set-up. However, this is not appropriate for non-personal interventions where programme costs are likely to comprise a substantial proportion of total costs, or for sectoral analysis where questions of how best to reallocate all existing health resources, including administrative resources, are being considered.This paper presents a first effort to systematically estimate programme costs for many health interventions in different regions of the world. The approach includes the quantification of resource inputs, choice of resource prices, and accounts for different levels of population coverage. By using an ingredients approach, and making tools available on the World Wide Web, analysts can adapt the programme costs reported here to their local settings. We report results for a selected number of health interventions and show that programme costs vary considerably across interventions and across regions, and that they can contribute substantially to the overall costs of interventions.