1. Sergio Bautista-Arredondo National Institute of Public Health Mexico
Cost Benefit / Cost Effectiveness Analysis Impact Evaluation Support Network Health Results-Based Financing
Sergio Bautista-Arredondo
National Institute of Public Health
Mexico

2. CBA and CEA
CBA – What is the net social benefit resulting from a program / intervention?
Measured in monetary terms
CEA – What is cost per unit of outcome “purchased” with an intervention?
Cost per birth attended by skilled health personnel
Cost per vaccinated child

3. Why in the context of impact evaluation?
Impact Evaluation tells whether an intervention works or not
What is the effect of the intervention?
CBA / CEA tells how much the effect costs
Efficiency implications
Equity implications

4. How to do it? Measure the consequences of the intervention
Effects
Costs
CBA : determine the net benefits C - E
Value effects in monetary terms
CEA : determine the cost per unit of outcome: C / E

5. Objective
Evaluate the efficiency and sustainability of different approaches of HRBF
Assess the incremental costs of these interventions, as well as their impact
To develop costing protocols for the country impact evaluations in the HRBF pilot projects
Appropriate to assess cost-effectiveness and cost-benefit of RBF interventions

6. Costing HRBF Measuring costs of the interventions
Relevant categories
Measuring issues
Data sources
Aggregating benefits / effects of the interventions
CBA
Willingness to pay
Other alternatives
DALYs
QUALYs

7. Costing HRBP Measuring costs of the interventions
Relevant categories
Measuring issues
Data sources
Aggregating benefits / effects of the interventions
CBA
Willingness to pay
Other alternatives
DALYs
QUALYs

8. Relevant Categories HRBF
Administration
Management of the programs
Implementation
Monetary incentives
Training / contracting staff
Increasing equipment
Monitoring system
Developing the system
Data entry and management
Audits and verification mechanisms
Staff

9. General vs Specific Important differences among countries:
Health System
M&E existing systems
HRBF interventions
Develop a general protocol that will have to be adapted in each country

10. Measuring Issues Perspective Time frame Measure initial / fixed costs
Implementing agency / agencies
Time frame
Measure the marginal/incremental costs of implementation between baseline and follow up
Able to assess the marginal cost of the impact observed
Measure initial / fixed costs
Measure ongoing / variable costs
Take scale into consideration

11. Data Sources Administrative data Survey data
Budget information from the three components
Survey data
Facility level surveys to assess
Allocation of resources to specific components of the program and to specific outcomes
Validate administrative data

12. Allocation of costs to outcomes
Labor L C I
Clinic
Capital
Inputs
Vaccined Children
Cancer tests performed
Controled diabetes patients

13. Costing HRBP Measuring costs of the interventions
Relevant categories
Measuring issues
Data sources
Aggregating benefits / effects of the interventions
CBA
Willingness to pay
Other alternatives
DALYs
QUALYs

14. Cost Benefit Analysis In order to aggregate different health outcomes:
Conduct cost-benefit analysis – we need to value in monetary terms the outcomes of the interventions
One approach: contingent valuation
Measuring wtp for contingent states or interventions
The objective is to determine the maximum monetary amount that individuals are willing to pay for the state or intervention
Estimate weights to add up different outcomes

15. Willingness to pay
Describing the hypothetical intervention that achieves the outcome of interest and eliciting the wtp from respondents:
Forces respondents to consider trade-offs between attributes
Makes the frame of reference explicit to respondents via the inclusion of an array of attributes and alternatives
Enables implicit prices to be estimated for attributes of interventions
Enables welfare impacts to be estimated for multiple scenarios

16. DALYs Disability adjusted life years (DALY)
DALYs for a disease are the sum of the years of life lost due to premature mortality (YLL) in the population and the years lost due to disability (YLD) for incident cases of the health condition
DALY = YLL + YLD

17. QUALYs
A quality-adjusted life-year (QALY) takes into account both quantity and the quality of life generated by healthcare interventions
It is the arithmetic product of life expectancy and a measure of the quality of the remaining life-years
Perfect health = 1 and Death = 0

18. Sources of data Household Survey Estimate QALYs or DALYs
Include a wtp module in the household questionnaire
Estimate QALYs or DALYs
These weights have been estimated for most common health outcomes
For different contexts