The health system burden of chronic disease care: an estimation of provider costs of selected chronic diseases in Uganda.

OBJECTIVE: To explore the chronic disease services in Uganda: their level of utilisation, the total service costs and unit costs per visit. METHODS: Full financial and economic cost data were collected from 12 facilities in two districts, from the provider's perspective. A combination of ingredients-based and step-down allocation costing approaches was used. The diseases under study were diabetes, hypertension, chronic obstructive pulmonary disease (COPD), epilepsy and HIV infection. Data were collected through a review of facility records, direct observation and structured interviews with health workers. RESULTS: Provision of chronic care services was concentrated at higher-level facilities. Excluding drugs, the total costs for NCD care fell below 2% of total facility costs. Unit costs per visit varied widely, both across different levels of the health system, and between facilities of the same level. This variability was driven by differences in clinical and drug prescribing practices. CONCLUSION: Most patients reported directly to higher-level facilities, bypassing nearby peripheral facilities. NCD services in Uganda are underfunded particularly at peripheral facilities. There is a need to estimate the budget impact of improving NCD care and to standardise treatment guidelines

Measuring and valuing societal and offender preferences for treatment programs - an economic perspective

IntroductionThe global offender population has rapidly increased over the past two decades. In Australia, incarceration rates have increased by 98% since 2000 with violent offences comprising the largest proportion. Research indicates that most violence can be classified as impulsive rather than premeditated, and that impulsive offenders are more likely to respond positively to treatment interventions than premeditated offenders. Despite the existence of interventions aimed at reducing reoffending, little is known about society’s or offenders’ preferences for such interventions, or value placed on them. This PhD aims to assess societal and offender perspectives and value placed on treatment programs for impulsive-violent offenders.MethodsA systematic review of economic evaluations of treatment programs for offenders highlighted the dearth of economic evidence. Two economic methods - discrete choice experiment (DCE) and contingent valuation (CV) – were used. A randomised control trial (REINVESt), providing pharmacotherapy treatment to impulsive-violent offenders, currently underway in New South Wales (Australia) provided the base for quantifying and valuing preferences. Prior to conducting the DCE and CV, qualitative methods (focus groups, in-depth interviews), priority setting methods of voting and ranking, and a Delphi method were undertaken to identify important characteristics of programs for impulsive-violent offenders. ResultsThe 23 characteristics generated using qualitative methods were reduced to 8 attributes and then used to develop the DCE and CV questionnaires. DCE results from 1021 community-based respondents demonstrated society’s preference for programs that: are more effective; provide full as opposed to partial treatment of co-occurring health conditions; are compulsory; have flexible appointments; and are continued post-prison. The CV study showed that society placed a high value for treatment programs such as REINVESt and were willing to pay an additional annual tax of $70 for them.ConclusionThe studies included in this thesis demonstrate that economic methods can be used to value programs in the justice area and provide a measure of the societal value/benefits of treatment programs for impulsive violent offenders. Additionally, this work demonstrates that when provided with relevant information, society places a positive value on treatment programs for impulsive-violent offenders

Are We Getting Value for Money from Behavioral Interventions for Offenders? A Research Note Reviewing the Economic Evaluation Literature

© 2017 Southern Criminal Justice Association Public expenditure on the criminal justice system represents a significant fiscal burden to government worldwide, making the economic evaluation of interventions aimed at improving justice outcomes critical to informing resource allocation. This study systematically reviews and assesses the scope and quality of economic evaluations of behavioral interventions aimed at reducing reoffending. Only seventeen studies met the inclusion criteria, with wide variation in methodological approaches, including differences in costing perspectives, study design, and the definition of cost and outcome measures. The majority of behavioral interventions for offenders remain unevaluated from an economic perspective, representing a significant evidence gap for informing cost-effective and efficient allocation decision. Based on the studies reviewed, economic benefit can be derived from investing in offender behavioral programs. However, whether this investment represents ‘value for money’ remains unclear. What is clear is that economic evaluations in the justice health sector lag behind research in other areas of public policy