Programme costs in the economic evaluation of health interventions

Johns, Benjamin; Baltussen, Rob; Hutubessy, Raymond

doi:10.1186/1478-7547-1-1

Cited by 265 publications

(142 citation statements)

References 16 publications

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“…intervention costs Country specific resource needs and costs were derived using the WHO-CHOICE database, 16 which includes detailed component specific estimates of inputs (ingredients) required for each intervention stage for each country's government and the estimated unit price for each input in that country including for example costs of human resources, training, meetings, supplies, equipment, and mass media (see supplementary eMethods). To facilitate comparisons between countries, we converted all costs to international dollars (I$) (see supplementary eMethods), which account for each nation's currency as well as purchasing power parity.…”

Section: Methods Sodium Reduction Interventionmentioning

confidence: 99%

Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations

Webb

Fahimi

Singh

et al. 2017

BMJ

114

105

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Objective To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide.Design Global modeling study.Setting 183 countries.Population Full adult population in each country.Intervention A “soft regulation” national policy that combines targeted industry agreements, government monitoring, and public education to reduce population sodium intake, modeled on the recent successful UK program. To account for heterogeneity in efficacy across countries, a range of scenarios were evaluated, including 10%, 30%, 0.5 g/day, and 1.5 g/day sodium reductions achieved over 10 years. We characterized global sodium intakes, blood pressure levels, effects of sodium on blood pressure and of blood pressure on cardiovascular disease, and cardiovascular disease rates in 2010, each by age and sex, in 183 countries. Country specific costs of a sodium reduction policy were estimated using the World Health Organization Noncommunicable Disease Costing Tool. Country specific impacts on mortality and disability adjusted life years (DALYs) were modeled using comparative risk assessment. We only evaluated program costs, without incorporating potential healthcare savings from prevented events, to provide conservative estimates of cost effectivenessMain outcome measure Cost effectiveness ratio, evaluated as purchasing power parity adjusted international dollars (equivalent to the country specific purchasing power of US$) per DALY saved over 10 years.Results Worldwide, a 10% reduction in sodium consumption over 10 years within each country was projected to avert approximately 5.8 million DALYs/year related to cardiovascular diseases, at a population weighted mean cost of I$1.13 per capita over the 10 year intervention. The population weighted mean cost effectiveness ratio was approximately I$204/DALY. Across nine world regions, estimated cost effectiveness of sodium reduction was best in South Asia (I$116/DALY); across the world’s 30 most populous countries, best in Uzbekistan (I$26.08/DALY) and Myanmar (I$33.30/DALY). Cost effectiveness was lowest in Australia/New Zealand (I$880/DALY, or 0.02×gross domestic product (GDP) per capita), although still substantially better than standard thresholds for cost effective (<3.0×GDP per capita) or highly cost effective (<1.0×GDP per capita) interventions. Most (96.0%) of the world’s adult population lived in countries in which this intervention had a cost effectiveness ratio <0.1×GDP per capita, and 99.6% in countries with a cost effectiveness ratio <1.0×GDP per capita.Conclusion A government “soft regulation” strategy combining targeted industry agreements and public education to reduce dietary sodium is projected to be highly cost effective worldwide, even without accounting for potential healthcare savings.

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Section: Methods Sodium Reduction Interventionmentioning

confidence: 99%

Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations

Webb

Fahimi

Singh

et al. 2017

BMJ

114

105

View full text Add to dashboard Cite

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“…The implementation costs were costs that occurred after the provision of DMP interventions to patients had started and included the costs for managing the DMP, the costs of multidisciplinary team meetings, the costs associated with collecting quality of care indicators for audit and feedback, the costs of materials used for patient education, and the costs of keeping the ICT operating. The development and implementation costs were systematically collected using a template based on the CostIt instrument of the World Health Organisation (WHO) [14]. This template was completed during face-to-face interviews with DMPs managers.…”

Section: Methodsmentioning

confidence: 99%

Changes in costs and effects after the implementation of disease management programs in the Netherlands: variability and determinants

Tsiachristas

Cramm

Nieboer

et al. 2014

Cost Eff Resour Alloc

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ObjectivesThe aim of the study was to investigate the changes in costs and outcomes after the implementation of various disease management programs (DMPs), to identify their potential determinants, and to compare the costs and outcomes of different DMPs.MethodsWe investigated the 1-year changes in costs and effects of 1,322 patients in 16 DMPs for cardiovascular risk (CVR), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DMII) in the Netherlands. We also explored the within-DMP predictors of these changes. Finally, a cost-utility analysis was performed from the healthcare and societal perspective comparing the most and the least effective DMP within each disease category.ResultsThis study showed wide variation in development and implementation costs between DMPs (range:€16;€1,709) and highlighted the importance of economies of scale. Changes in health care utilization costs were not statistically significant. DMPs were associated with improvements in integration of CVR care (0.10 PACIC units), physical activity (+0.34 week-days) and smoking cessation (8% less smokers) in all diseases. Since an increase in physical activity and in self-efficacy were predictive of an improvement in quality-of-life, DMPs that aim to improve these are more likely to be effective. When comparing the most with the least effective DMP in a disease category, the vast majority of bootstrap replications (range:73%;97) pointed to cost savings, except for COPD (21%). QALY gains were small (range:0.003;+0.013) and surrounded by great uncertainty.ConclusionsAfter one year we have found indications of improvements in level of integrated care for CVR patients and lifestyle indicators for all diseases, but in none of the diseases we have found indications of cost savings due to DMPs. However, it is likely that it takes more time before the improvements in care lead to reductions in complications and hospitalizations.

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“…Health workforce wages were first estimated by WHO-CHOICE based on ILO data in 2000 [11]. A comparison of inflated data from the earlier analysis to the more recent ILO data shows some interesting trends in wages over time.…”

Section: Discussionmentioning

confidence: 99%

“…Cross country estimates on the cost of health interventions help in this respect both donor agencies such as Gavi and the Global Fund, and international organizations, such as the World Health Organization. Recognizing a need for publicly available information on the costs and cost-effectiveness for health interventions, the WHO-CHOICE programme has made available since 2000, a database of price estimates of various intervention inputs for use in the economic and financial analyses of health care interventions [11]. …”

Section: Introductionmentioning

confidence: 99%

Global health worker salary estimates: an econometric analysis of global earnings data

Serje

Bertram

Brindley

et al. 2018

Cost Eff Resour Alloc

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BackgroundHuman resources are consistently cited as a leading contributor to health care costs; however the availability of internationally comparable data on health worker earnings for all countries is a challenge for estimating the costs of health care services. This paper describes an econometric model using cross sectional earnings data from the International Labour Organization (ILO) that the World Health Organizations (WHO)-Choosing Interventions that are Cost-effective programme (CHOICE) has used to prepare estimates of health worker earnings (in 2010 USD) for all WHO member states.MethodsThe ILO data contained 324 observations of earnings data across 4 skill levels for 193 countries. Using this data, along with the assumption that data were missing not at random, we used a Heckman two stage selection model to estimate earning data for each of the 4 skill levels for all WHO member states.ResultsIt was possible to develop a prediction model for health worker earnings for all countries for which GDP data was available. Health worker earnings vary both within country due to skill level, as well as across countries. As a multiple of GDP per capita, earnings show a negative correlation with GDP—that is lower income countries pay their health workers relatively more than higher income countries.ConclusionsLimited data on health worker earnings is a limiting factor in estimating the costs of global health programmes. It is hoped that these estimates will support robust health care intervention costings and projections of resources needs over the Sustainable Development Goal period.Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0093-z) contains supplementary material, which is available to authorized users.

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Programme costs in the economic evaluation of health interventions

Cited by 265 publications

References 16 publications

Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations

Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations

Changes in costs and effects after the implementation of disease management programs in the Netherlands: variability and determinants

Global health worker salary estimates: an econometric analysis of global earnings data

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