Results showed that participation in HA/DR was associated with significant reductions in PTSD symptoms, depressive symptoms, and the use of antidepressants by service members. Further research needs to understand the mechanism of these associations for better planning and implementation of HA/DR and delivery of care to service members who participate in these missions.

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Measuring the effectiveness of military Global Health Engagements (GHEs) has become an area of increasing interest to the military medical field. As a result, there have been efforts to more logically and rigorously evaluate GHE projects and programs; many of these have been based on the Logic and Results Frameworks. However, while these Frameworks are apt and appropriate planning tools, they are not ideally suited to measuring programs' effectiveness. This article introduces military medicine professionals to the Measures of Effectiveness for Defense Engagement and Learning (MODEL) program, which implements a new method of assessment, one that seeks to rigorously use Measures of Effectiveness (vs. Measures of Performance) to gauge programs' and projects' success and fidelity to Theater Campaign goals. While the MODEL method draws on the Logic and Results Frameworks where appropriate, it goes beyond their planning focus by using the latest social scientific and econometric evaluation methodologies to link on-the-ground GHE "lines of effort" to the realization of national and strategic goals and end-states. It is hoped these methods will find use beyond the MODEL project itself, and will catalyze a new body of rigorous, empirically based work, which measures the effectiveness of a broad spectrum of GHE and security cooperation activities. We based our strategies on the principle that it is much more cost-effective to prevent conflicts than it is to stop one once it's started. I cannot overstate the importance of our theater security cooperation programs as the centerpiece to securing our Homeland from the irregular and catastrophic threats of the 21st Century.-GEN James L. Jones, USMC (Ret.).

Background: Under the current paradigm, cost-effectiveness studies provide limited value to policy makers in low-resource settings. Studies appear with substantial delays in the academic literature and are often based on large-scale multi-intervention assessments in settings with drastically different infrastructure, resources and cultures. Timely and contextual evidence is rarely available. Given recent developments in standardizing the analysis of the global burden of disease (GBD), we believe a similar approach can be applied to the generation of costeffectiveness estimates. To achieve this, we are developing a systematic protocol and guidelines for conducting cost-effectiveness analyses based on the integration of information. We are applying this approach to two low-income countries e Kenya and Zambia e as a proof of concept. Methods: We define cost-effectiveness as a combination of five inputs: incremental costing, the current coverage of interventions, the remaining burden of disease that needs to be addressed, efficacy of interventions, and the gap between efficacy and effectiveness, which we label as quality. The first step is to identify a set of interventions based on highest potential impact and strategic priorities of the two countries involved. The list of interventions for Kenya is currently being finalized. To develop cost functions, we will use data collected through the Access, Bottlenecks, Costs and Equity (ABCE) project that incorporate facilitylevel efficiency. GBD estimates will be used to determine the burden. We will initially develop first order approximations of coverage based on available survey data, or encounter data for interventions that are not normally included in demographic health surveys. We will map from efficacy in the units reported in the literature to changes in disabilityadjusted life years (DALYs) checking for consistency with GBD assumptions regarding prevalence, case-fatality rates, severity distributions and disability weights. To account for the impact of provider quality and consumer behavior on the real-world effectiveness of interventions, we are collaborating with Emory University in developing a framework to estimate effectiveness and its determinants. Findings: Bringing together data on the five inputs will allow us to produce estimates of the cost-effectiveness of the interventions of interest to policy makers in Kenya and Zambia. We aim to produce our first round of estimates in 2015 for a subset of those interventions. Interpretation: Developing a system that is able to generate timely, evidence-based, setting-specific and up-to-date estimates of cost-effectiveness for each country will take multiple iterations. Ultimately, the aim is to be able to determine the fraction of each disease that can be averted over a defined period with policies that meet certain threshold definitions of cost per DALY averted, while incorporating uncertainty.