health economics workshop: costing tools · health economics workshop: costing tools monisha...
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HealthEconomicsWorkshop:
CostingToolsMonishaSharma,PhD
InternationalClinicalResearchCenter(ICRC)UniversityofWashington
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Reminder:usesofcostdata
Resourcerequirementsandadvocacy
Prioritysettingfornewinterventionsorintroducingnew
technologies,drugs,vaccines
Financialplanningandbudgeting/information
onsustainability
Economicevaluation/Improvingtechnicalefficiency
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• Budgetplanning: Governmentsandlocalhealthagenciescanusetoolstohelpinplanningandbudgetingprocesses• Decisionmaking:Targetcoverage,eg 50%ofHIVpositivepersonsonARTorimpactguided:30%reductioninHIVincidence.
• Costinginterventionsandhealthoutcomes:Determiningthecostsandeffectiveness(e.g.deathordiseaseaverted)associatedwithdifferentinterventions.Conductingacost-effectivenessanaylsis
Usesofcostingtools
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• Provideinformationonthecostofscalingupandsustaininghealthprogramsatdifferentlevelsofthehealthsystem(andevenforglobalprograms)• Aimtoinformdecisionmakingandprogrammingtoachievespecificgoals(i.e.sustainabledevelopmentgoals)• Helpevaluateprogresstowardshealthtargets,egMillenniumdevelopmentgoals:17healthgoalstobemetoverthenext15years.
Costingtoolscan:
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•Determine:• Costofscaleuppackageofinterventions•Costofachievingtargetcoverage•Costofstrategicmulti-yearplan• Impactofresourceallocationonanoutcome
Focusoftools:
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• Mostofthetoolsaredesignedtobeusedafterformaltraining• Althoughitispossibletodownloadandlearnthetoolsonyourown
• It’sdifficulttounderstandhowthetoolsoperate(blackboxes).Evenwithuserguidesthecomputationsarenotclearlyoutlined• MostareExcel-based• Usetheingredients/bottom-upcosting• Eachtoolusesadifferentapproachanddifferentlogic.Optimaltooldependsonresearchquestionandavailabledata.
Characteristicsofcostingtools
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• Costtoolsusetwobasicproductionfunctions• Interventionproductionfunction:Calculatedbymultiplyingthepriceofaninput(eg unitcostofcondom)timesthequantityofinputsused(#ofcondomsdistributed• Cost*Quantity
• Healthproductionfunction: Calculatedbymultiplyingthenumberofpersonsservedbyaninterventiontimestheeffectivenessoftheintervention(eg #ofadultsservedbynutritionalinterventiontimeseffectivenessofinterventioninreducingmalnutrition.• Coverage*effectiveness
Howdothetoolscalculatecostandimpact?
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• ChildhealthinterventioninvolvingdistributingvitaminAtochildrenusingcommunityhealthworkersathealthfairswiththegoalofreducing<5mortality
• Healthproductionfunction:#ofchildrenserved*effectivenessinreducing<5mortality• Costproductionfunction:Unitcostof2vitaminAcapsules*#childrenreached+#healthworkersneeded*#ofdaystheywork*dailypayrate+costofeachcommunityawarenesscampaign*#ofcampaigns
E.g.VitaminAsupplementationprogram
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• Mosttoolsarepre-populatedwithcostsfordifferenthealthinterventions,countrydemographics,interventioneffectiveness• Somedataarebetterthanothers—itsimportanttocheckthemodelassumptionsandmakesuretheyareaccurateforyouranalysis.Manyparametersneedtobereplacedtorepresentcontextofyouranalysis.
Datarequirementsfortools
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Selectionofcostingtools
• DecisionMakersProgramPlanningTool(DMPPT)• ReproductiveHealth(RH)CostingTool• IntegratedHealthcareTechnologyPackage(iHTP)
SimulationTool• Spectrum:PMTCTCostEffectiveness• GoalsModel• Planning,CostingandBudgetingFramework(PCBF)• COREPlus• IntegratedHealthModel• Planning&BudgetingforTBControl• ResourceNeedsModelHIV/AIDS• OneHealthModel(synthesisofallmodelingtools)
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DecisionMakersProgramPlanningTool(DMPPT)developedbyUNAIDS
• Excel-basedmodelthatcanestimatecostsandeffectiveness(infectionsaverted)associatedwithdifferentscenariosofmalecircumcision(MC)scale-up.
• Scenarioscanvary:• Prioritypopulations:allmales,youngadults,newborns,ormost-at-riskgroups• Coveragelevelsandscale-uprates• Servicedeliverymodes:hospital,clinic,mobilevan;public,private,NGO• SurgicaltechniqueusedforMC,kitused• Taskshifting,tasksharing• Riskcompensation• Maleà FemaletransmissionreductionwithMC• Populationage-structure,birthandmortalityrate• Sexualbehavior• Discounting
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Decision Makers Program Planning Tool
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Results:CostsofscalingupVMCto80%bycountry
ExampleofanalysisconductedwithDMPPT
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Example:GoalsTool
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• UsedtoestimatethecosteffectivenessofscalingupHIVself-testingin3developingcountries
Example:SpectrumModel
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Deathsaverted
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Infectionsaverted
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DALYSaverted
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DeathsavertedinHanoi(possiblebug)
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Choosingtherighttool:SummaryofcostingtoolsavailablethruWHO
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Choosingtherighttool
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ChildHealth HIV/AIDS/TB/Malaria Reproductivehealth
General
Child HealthCostEstimationtoolCHCET
GoalsModel HIV/AIDS ReproductiveHealthCostingTool
CostRevenueAnalysisToolPlus(COREplus
cMYP-ComprehensivemultiyearplanImmunization
Malaria costestimationtool
Integrated HealthcareTechnologyPackage(iHTP)
Planning&BudgetingforTBControl
IntegratedHealthModel(IHM)
ResourceneedsModelHIV/AIDS
MarginalBudgetingforBottlenecks(MBB)
Spectrum PMTCTCE Planning,costingandbudgetingframework(PCBF)
OptimizeHIV/AIDS OneHealth
Categoriestoolsbyhealthintervention
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• Coverageguideddecisionmakingwithbudgetconstraint• Impactguideddecisionmakingwithbudgetconstraint• Short-term1year• Mediumtermfocus(1-10years)• Longtermfocus(10+years)• Mostmeasurequantitiesandpricesassociatedwithactivities
Methodsused?
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• Averagecostperintervention• Totalcost• Scaleupcost• Fundinggap• Resourcebottleneck• Coverage• Impactonhealthoutcome• Budget• Summarytableofcostsand/orbenefits• Graphs
Typesofoutputsfromthesetools
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Otheranalysesconductedwithcostingtools
Toolsusedby:WHO,UNAIDSCommissions,eg LancetcommissiononGlobalHealth2035whichestimatedcosttoscaleupinterventionstolowermortalityratesindevelopingcountries.Thismaybeacademicorresearchorganizationswhodothework.Nationalgovernmentsusetoolsintheirhealthsectorstrategicplanning—eitherMOHstafforconsultants
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• WHOGuidesummarizingavailablecostingtools:http://www.who.int/pmnch/knowledge/publications/costing_tools/en/
THANKYOU