1. WHAT IS HEALTH ECONOMICS?
ACCOUNTANTS CARE ONLY ABOUT $$$$$$$$$$
PHYSICIANS CARE ONLY ABOUT PATIENTS……
HEALTH ECONOMISTS CARE ABOUT RESOURCE$ AND PATIENTS
ECONOMICS IS HOW TO ALLOCATE SCARCE RESOURCES

2. COST-EFFECTIVENESS ANALYSIS (CEA)5 10 4
The cheapest method of attaining
the SAME GOAL
is the most cost-effective.

3. CHRONIC RENAL DISEASE (Klareman)
HOSP DIALYSIS ($104,000)
9 years gained. CPLY=$11,600
HOME DIALYSIS ($38,000)
9 years gained. CPLY=$4,200
TRANSPLANT ($44,500)
17 years gained CPLY=$2,600

4. COST-UTILITY ANALYSIS

5. BURDEN

6. Process I 2. Analysis, Epi review parameters 4. Burden Estimates 3.1.
Literature
search 4.
Burden
Estimates 3.
Country
data

7. BURDEN
SCENARIOS

9. SCENARIOS
BURDEN
PROGRAM
COSTS

10. BURDEN
SCENARIOS
VACCINE
PROGRAM
COSTS
DISEASE
TREATMENT
COSTS

11. + COSTS OF DISEASE SEQUELLAE
Utilisation Rates for: self-care, self care +medication/herbs, traditional healer, community clinic/GP, in-hospital care, intensive care, out-patient visits.
DISEASE
TREATMENT
COSTS X
Unit Costs, including Laboratory tests, Pharmaceuticals and Medications.
+ COSTS OF DISEASE SEQUELLAE

12. NET COST PER DALY Net Cost = Cost of Intervention less
Averted Treatment Costs
DALYS = sum of life years saved due to decreased mortality + life years saved due to decreased morbidity + reduction in caregiver burden

13. DALY LOSS PER FRACTURE
bibliog adj to israel

14. COST-UTILITY ANALYSIS
NET COST
DALY
PER: LIFE YEAR GAINED
LIFE SAVED
CASE-PREVENTED
COST-UTILITY ANALYSIS

15. COST SAVING IF savings in treatment costs > program costs
then we can reduce mobidity and mortality AT NO NET COST
STRONG PSYCHOLOGICAL PUSH FOR PROGRAMME

16. VERY COST EFFECTIVE
Project considered acceptable in relation to resources available in individual countries
CPDALY < GNP per head

17. COST EFFECTIVE
Project considered acceptable in relation to resources available in individual countries
CPDALY < 3 x GNP per head

18. ALBANIA has $1,120 GNP per Head, CPDALY for HIB=$347
CPDALY < 3 x GNP per head
VERY cost-effective if
WHO report, says project is cost-effective if
CPDALY < GNP per head

20. Disease Clubs
Many donors adopt specific diseases, creating jobs and disease clubs, who advocate using burden data, but avoid true comparisons of interventions using CEA.

28. INFECTIOUS NCD Good efficacy data, short length of trials
Hard to model herd immunity
Poor efficacy data due to long term needed for results (statins, latency period)

29. Prevention Programmes
Eg: smoking cessation or dietary control
Very little population based efficacy data as trials usually were on specific populations such as persons employed in factory etc.

30. GCEA: THREE PROGRAMME EXAMPLE
A = Operation on rare disease (Cost = $1m, QALYS saved = 1)
B = Operation and drug treatment for rare disease (Cost = $1,001,000, QALYS saved = 2)
C = Preventive Nutritonal Campaign (Cost = $1,001,000, QALYS= 500)

31. Cost = $ 1,001,000 QALY=500 CPQALY= $2,000 QUALYSB A C 1m
Cost =
$ 1,001,000
QALY=500
CPQALY=
$2,000
A to B, get 1 QALY for
$1000 CPQALY = $,1000 1 2
QUALYS
500

32. INCREMENTAL CEA
CHOOSE B SINCE CPQALY = $1,000 cf
$2000 for nutrition programme

33. $
CPQ=$1,000,000 B A C 1m
CPQ= $500,500
CPQ=2,000 1 2
QUALYS
500

34. GENERALISED CEA CALCULATE NULL SETTING WHERE NO INTERVENTION OCCURS
CALCULATE ALL INTERVENTIONS WITH RESPECT TO NULL
CHOOSE INTERVENTION C AND GAIN
= 1998 QALYS

35. COST per QALY ($)

36. CEA or CUA
TRANSPARENT, MORE DEMOCRATIC METHOD OF CHOOSING PROGRAMMES THAN BY MARKET, PRESSURE GROUPS, DONOR GROUPS ETC.
BIASED AGAINST ELDERLY AND HANDICAPPED!
MORE EFFICIENT METHOD IN TERMS OF MAXIMISING HEALTH OUTPUT (DALYS- reflecting mortality and morbidity gains)

37. HEALTH ECONOMICS
WITHOUT
HEALTH ECONOMICS

38. THANK YOU ………...….…..opportunity cost