2 research outputs found
Cost-effectiveness analysis for sector-wide priority setting in health
Cost-effectiveness analysis (CEA) provides one means by which decision-makers may
assess and potentially improve the performance of health systems. The process can
help to ensure that resources devoted to health systems are achieving the maximum
possible benefit in terms of outcomes that people value. Over the past three decades
there has been an exponential growth in the number of economic appraisals performed
in health. Following standard textbooks on economic evaluations, most of these CEA
studies pursue an incremental approach which requires comparison of the additional
costs of an intervention over current practice with additional health benefits. Such
an incremental approach, however, is unable to provide policy makers with all necessary
information relating to decisions like: "Do the resources currently devoted to health
achieve as much as they could?", or "How best to use additional resources if they
become available?".
This thesis proposes a broader sectoral approach via the application of a generalized
CEA framework which also al!ows examination of existing inefficiencies in the health
system- that is, the wide variations in CE ratios observed among interventions that are
currently in use suggest there is considerable room to improve efficiency by moving from
inefficient interventions currently in use to efficient interventions that are under-utilised. In developing countries in particular reallocation of scarce financial resources is most
important
Lifetime health effects and costs of diabetes treatment
BACKGROUND: This article presents cost-effectiveness analyses of the major
diabetes interventions as formulated in the revised Dutch guidelines for
diabetes type 2 patients in primary and secondary care. The analyses
consider two types of care: diabetes control and the treatment of
complications, each at current care level and according to the guidelines.
METHODS: A validated probabilistic diabetes model describes diabetes and
its complications over a lifetime in the Dutch population, computing
quality-adjusted life years and medical costs. Effectiveness data and
costs of diabetes interventions are from observational current care
studies and intensive care experiments. Lifetime consequences of in total
sixteen intervention mixes are compared with a baseline glycaemic control
of 10% HBA1C. RESULTS: The interventions may reduce the cumulative
incidence of blindness, lower-extremity amputation, and end-stage renal
disease by >70% in primary care and >60% in secondary care. All primary
care guidelines together add 0.8 quality-adjusted life years per lifetime.
CONCLUSION: In case of few resources, treating complications according to
guidelines yields the most health benefits. Current care of diabetes
complications is inefficient. If there are sufficient resources, countries
may implement all guidelines, also on diabetes control, and improve
efficiency in diabetes care