196 research outputs found
The Brexit question will increase financial market volatility
That is the nearly unanimous response in a survey of leading experts, writes a Centre for Macroeconomics tea
Eflornithine is a cost-effective alternative to melarsoprol for the treatment of second-stage human West African trypanosomiasis in Caxito, Angola.
OBJECTIVE: To compare the cost-effectiveness of eflornithine and melarsoprol in the treatment of human African trypanosomiasis. METHOD: We used data from a Médecins Sans Frontières treatment project in Caxito, Angola to do a formal cost-effectiveness analysis, comparing the efficiency of an eflornithine-based approach with melarsoprol. Endpoints calculated were: cost per death avoided; incremental cost per additional life saved; cost per years of life lost (YLL) averted; incremental cost per YLL averted. Sensitivity analysis was done for all parameters for which uncertainty existed over the plausible range. We did an analysis with and without cost of trypanocidal drugs included. RESULTS: Effectiveness was 95.6% for melarsoprol and 98.7% for eflornithine. Cost/patient was 504.6 for melarsoprol and 552.3 for eflornithine, cost per life saved was 527.5 USD for melarsoprol and 559.8 USD for eflornithine without cost of trypanocidal drugs but it increases to 600.4 USD and 844.6 USD per patient saved and 627.6 USD and 856.1 USD per life saved when cost of trypanocidal drugs are included. Incremental cost-effectiveness ratio is 1596 USD per additional life saved and 58 USD per additional life year saved in the baseline scenario without cost of trypanocidal drugs but it increases to 8169 USD per additional life saved and 299 USD per additional life year saved if costs of trypanocidal drugs are included. CONCLUSION: Eflornithine saves more lives than melarsoprol, but melarsoprol is slightly more cost-effective. Switching from melarsoprol to eflornithine can be considered as a cost-effective option according to the WHO choice criteria
Developing a model to estimate the potential impact of municipal investment on city health
This article summarizes a process which exemplifies the potential impact of municipal investment on the burden of cardiovascular disease (CVD) in city populations. We report on Developing an evidence-based approach to city public health planning and investment in Europe (DECiPHEr), a project part funded by the European Union. It had twin objectives: first, to develop and validate a vocational educational training package for policy makers and political decision takers; second, to use this opportunity to iterate a robust and user-friendly investment tool for maximizing the public health impact of 'mainstream' municipal policies, programs and investments. There were seven stages in the development process shared by an academic team from Sheffield Hallam University and partners from four cities drawn from the WHO European Healthy Cities Network. There were five iterations of the model resulting from this process. The initial focus was CVD as the biggest cause of death and disability in Europe. Our original prototype 'cost offset' model was confined to proximal determinants of CVD, utilizing modified 'Framingham' equations to estimate the impact of population level cardiovascular risk factor reduction on future demand for acute hospital admissions. The DECiPHEr iterations first extended the scope of the model to distal determinants and then focused progressively on practical interventions. Six key domains of local influence on population health were introduced into the model by the development process: education, housing, environment, public health, economy and security. Deploying a realist synthesis methodology, the model then connected distal with proximal determinants of CVD. Existing scientific evidence and cities' experiential knowledge were 'plugged-in' or 'triangulated' to elaborate the causal pathways from domain interventions to public health impacts. A key product is an enhanced version of the cost offset model, named Sheffield Health Effectiveness Framework Tool, incorporating both proximal and distal determinants in estimating the cost benefits of domain interventions. A key message is that the insights of the policy community are essential in developing and then utilising such a predictive tool
Income and Health in Cities: the Messages from Stylized Facts
The benefits of good health to individuals and to society are strongly positive, and improving the health of the poor is a key millennium development goal (MDG). A typical health strategy advocated by some calls for increased public spending on health targeted to favor the poor backed by foreign assistance, combined with an international effort to perfect drugs and vaccines to ameliorate the major infectious diseases prevalent in developing nations. However, if the objective is better health outcomes at the least cost and a reduction in urban health inequity, our research suggests that the four most potent policy interventions are: improving access to clean water and sanitation; widely available primary care and health programs aimed at influencing diets and lifestyles; raising the level of education; and better urban land use and transport planning which contains urban sprawl and minimizes the trend towards sedentary living habits. The payoff from these four, in terms of health outcomes especially for those in low-income categories, dwarfs the returns from new drugs and curative hospital-based medicine, although these certainly have their place in a modern urban health system. We find, moreover, that the resource requirements for successful health care policies are likely to depend on an acceleration of economic growth rates, which increase household purchasing power and enlarge the pool of resources available to national and subnational governments to invest in and maintain health-related infrastructure and services. Thus, an acceleration of growth rates may be necessary to sustain a viable urban health strategy, which is equitable, and to ensure steady gains in health outcomes
Methods for economic evaluation of a factorial-design cluster randomised controlled trial of a nutrition supplement and an exercise programme among healthy older people living in Santiago, Chile: the CENEX study
BACKGROUND: In an effort to promote healthy ageing and preserve health and function, the government of Chile has formulated a package of actions into the Programme for Complementary Food in Older People (Programa de Alimentación Complementaria para el Adulto Mayor - PACAM). The CENEX study was designed to evaluate the impact, cost and cost-effectiveness of the PACAM and a specially designed exercise programme on pneumonia incidence, walking capacity and body mass index in healthy older people living in low- to medium-socio-economic status areas of Santiago. The purpose of this paper is to describe in detail the methods that will be used to estimate the incremental costs and cost-effectiveness of the interventions. METHODS AND DESIGN: The base-case analysis will adopt a societal perspective, including the direct medical and non-medical costs borne by the government and patients. The cost of the interventions will be calculated by the ingredients approach, in which the total quantities of goods and services actually employed in applying the interventions will be estimated, and multiplied by their respective unit prices. Relevant information on costs of interventions will be obtained mainly from administrative records. The costs borne by patients will be collected via exit and telephone interviews. An annual discount rate of 8% will be used, consistent with the rate recommended by the Government of Chile. All costs will be converted from Chilean Peso to US dollars with the 2007 average period exchange rate of US$1 = 522.37 Chilean Peso. To test the robustness of model results, we will vary the assumptions over a plausible range in sensitivity analyses. DISCUSSION: The protocol described here indicates our intent to conduct an economic evaluation alongside the CENEX study. It provides a detailed and transparent statement of planned data collection methods and analyses. TRIAL REGISTRATION: ISRCTN48153354
Population health metrics: crucial inputs to the development of evidence for health policy
Valid, reliable and comparable measures of the health states of individuals and of the health status of populations are critical components of the evidence base for health policy. We need to develop population health measurement strategies that coherently address the relationships between epidemiological measures (such as risk exposures, incidence, and mortality rates) and multi-domain measures of population health status, while ensuring validity and cross-population comparability. Studies reporting on descriptive epidemiology of major diseases, injuries and risk factors, and on the measurement of health at the population level – either for monitoring trends in health levels or inequalities or for measuring broad outcomes of health systems and social interventions – are not well-represented in traditional epidemiology journals, which tend to concentrate on causal studies and on quasi-experimental design. In particular, key methodological issues relating to the clear conceptualisation of, and the validity and comparability of measures of population health are currently not addressed coherently by any discipline, and cross-disciplinary debate is fragmented and often conducted in mutually incomprehensible language or paradigms. Population health measurement potentially bridges a range of currently disjoint fields of inquiry relating to health: biology, demography, epidemiology, health economics, and broader social science disciplines relevant to assessment of health determinants, health state valuations and health inequalities. This new journal will focus on the importance of a population based approach to measurement as a way to characterize the complexity of people's health, the diseases and risks that affect it, its distribution, and its valuation, and will attempt to provide a forum for innovative work and debate that bridge the many fields of inquiry relevant to population health in order to contribute to the development of valid and comparable methods for the measurement of population health and its determinants
Iron fortification and iron supplementation are cost-effective interventions to reduce iron deficiency in four subregions of the world
Iron deficiency is the most common and widespread nutritional disorder in
the world, affecting millions of people in both nonindustrialized and
industrialized countries. We estimated the costs, effects, and
cost-effectiveness of iron supplementation and iron fortification
interventions in 4 regions of the world. The effects on population health
were arrived at by using a population model designed to estimate the
lifelong impact of iron supplementation or iron fortification on
individuals benefiting from such interventions. The population model took
into consideration effectiveness, patient adherence, and geographic
coverage. Costs were based on primary data collection and on a review of
the literature. At 95% geographic coverage, iron supplementation has a
larger impact on population health than iron fortification. Iron
supplementation would avert <12,500 disability adjusted life years (DALY)
annually in the European subregion, with very low rates of adult and child
mortality, to almost 2.5 million DALYs in the African and Southeast Asian
subregions, with high rates of adult and child mortality. On the other
hand, fortification is less costly than supplementation and appears to be
more cost effective than iron supplementation, regardless of the
geographic coverage of fortification. We conclude that iron fortification
is economically more attractive than iron supplementation. However,
spending the extra resources to implement iron supplementation is still a
cost-effective option. The results should be interpreted with caution,
because evidence of intervention effectiveness predominantly relates to
small-scale efficacy trials, which may not reflect the actual effect under
expected conditions
Catastrophic payments for health care in Asia
Out-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that are catastrophic, in the sense of severely disrupting household living standards, and approximate such payments by those absorbing a large fraction of household resources. Bangladesh, China, India, Nepal and Vietnam rely most heavily on OOP financing and have the highest incidence of catastrophic payments. Sri Lanka, Thailand and Malaysia stand out as low to middle income countries that have constrained both the OOP share of health financing and the catastrophic impact of direct payments. In most low/middle-income countries, the better-off are more likely to spend a large fraction of total household resources on health care. This may reflect the inability of the poorest of the poor to divert resources from other basic needs and possibly the protection of the poor from user charges offered in some countries. But in China, Kyrgyz and Vietnam, where there are no exemptions of the poor from charges, they are as, or even more, likely to incur catastrophic payments
The utilisation of health research in policy-making: Concepts, examples and methods of assessment
The importance of health research utilisation in policy-making, and of understanding the
mechanisms involved, is increasingly recognised. Recent reports calling for more resources to
improve health in developing countries, and global pressures for accountability, draw greater
attention to research-informed policy-making. Key utilisation issues have been described for at
least twenty years, but the growing focus on health research systems creates additional dimensions.
The utilisation of health research in policy-making should contribute to policies that may eventually
lead to desired outcomes, including health gains. In this article, exploration of these issues is
combined with a review of various forms of policy-making. When this is linked to analysis of
different types of health research, it assists in building a comprehensive account of the diverse
meanings of research utilisation.
Previous studies report methods and conceptual frameworks that have been applied, if with varying
degrees of success, to record utilisation in policy-making. These studies reveal various examples of
research impact within a general picture of underutilisation.
Factors potentially enhancing utilisation can be identified by exploration of: priority setting;
activities of the health research system at the interface between research and policy-making; and
the role of the recipients, or 'receptors', of health research. An interfaces and receptors model
provides a framework for analysis.
Recommendations about possible methods for assessing health research utilisation follow
identification of the purposes of such assessments. Our conclusion is that research utilisation can
be better understood, and enhanced, by developing assessment methods informed by conceptual
analysis and review of previous studies
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