Pre conference workshop Economic Evaluations of Public Health Interventions
Amsterdam, EUPHA 2010
Public health economics was one of the themes of a pre conference at the 3rd European Public Health Conference in Amsterdam that took place from 10-13 November of 2010. Around 40 people participated at this pre conference. In four presentations the main topics in Public Health economics were introduced and illustrated. Economics is concerned with allocation of scarce resources in society over alternative uses. Some different types of evaluations were shown. The preference (utility) based health measure QALY (Quality Adjusted Life Years) was explained and discussed. In general methods for economic evaluations can be applied for evaluation of Public Health interventions. This was illustrated by a presentations on the economic impact of prevention strategies in tackling obesity. This study showed some good results in improving population health and decreasing health expenditure. However in many Public Health areas the effectiveness of public health interventions is still limited and should be assessed carefully concerning assumptions, costs calculated and models used.
More attention should be paid to inter-sectoral effects, equity considerations and a societal perspective in performing economic evaluations. Finally the involvement of relevant stakeholders is key to the success of Prevention.
The chair of this meeting concluded that Public Health and Economics could make a good couple. However for a longstanding relationship, we should put more effort in the evidence base of Public Health interventions. It is important that Public Health interventions demonstrate value for money!
Comparative Effectiveness: UCSF East Africa Global Health -Kisumu 2014GlobalResearchUCSF
The document describes an upcoming cost-effectiveness analysis workshop to be held in Kisumu, Kenya on January 20, 2014. The purpose of the workshop is to provide participants with a basic understanding of cost-effectiveness analysis concepts and methods and allow them to apply these concepts to an issue of their choosing. The workshop will cover core CEA approaches such as calculating incremental cost per standardized unit of health gain compared to alternative interventions and key metrics like the incremental cost-effectiveness ratio. The workshop aims to provide participants with a foundation for further developing CEA ideas and projects.
The document discusses compression stockings used to prevent deep vein thrombosis (DVT) during flights. It notes that in trials, stockings were below-knee compression of 10-30 mm Hg strength. It emphasizes proper fitting is important as stockings that are too tight can cut skin or prevent blood flow. It recommends wearing stockings before travel to ensure comfort and notes cost and availability can vary.
This document provides an overview of cost-benefit analysis as an economic evaluation technique. It discusses key aspects of CBA including:
- Measuring both costs and benefits in monetary terms, with an intervention undertaken if benefits exceed costs.
- Perspectives taken including patient, provider, and societal.
- Methods for measuring costs such as direct, indirect, and intangible costs.
- Methods for measuring monetary value of benefits including cost of illness averted and contingent valuation using willingness to pay.
- An example cost-benefit analysis of interventions to reduce cholera cases in an area.
This document discusses economic evaluation in healthcare decision making. It defines economic evaluation as using scientific methods to compare costs and benefits of alternative interventions. The main types of economic evaluation are described as cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, and cost-minimization analysis. The document outlines the generic steps in economic evaluation including defining the question, identifying and valuing costs and benefits, analyzing costs and benefits, and determining decision rules based on incremental cost-effectiveness ratios. Limitations of economic evaluation for resource allocation are discussed, noting that many factors beyond cost-effectiveness play a role in funding decisions.
Economic evaluations in clinical research compare the costs and health outcomes of interventions to determine value. They are increasingly important as healthcare spending rises. Common methods include cost-effectiveness analysis, which calculates cost per health outcome gained, and cost-utility analysis, which measures cost per quality-adjusted life year. However, economic evaluations face challenges in standardizing costs and accounting for factors like inflation over time.
This clinical guideline discusses the importance of providing high-value healthcare by evaluating the benefits, harms, and costs of medical interventions. It outlines three key concepts: 1) Assessing the benefits, harms, and costs of interventions is essential to understand their value. 2) The cost of an intervention should include downstream costs. 3) The incremental cost-effectiveness ratio estimates the additional cost required to gain more health benefits and provides a measure of an intervention's value. Evaluating value can help identify care that provides no benefit or may be harmful, as well as care that provides good value relative to its costs.
This document provides an overview of cost modeling and cost-effectiveness analysis. It discusses why these analyses are important, distinguishing between costs and charges and efficacy versus effectiveness. It also covers defining value, common study types like cost-effectiveness analysis and cost-utility analysis, and ways to communicate results such as using an incremental cost-effectiveness ratio and evidence rating matrix. Decision-analytic modeling is presented as a key approach to extrapolate short-term results to long-term outcomes.
Zeeshan Ayyaz of Amitiel Welfare Society in Bahawalpur, Pakistan thanks UNAIDS for HIV awareness and prevention materials. He distributed these materials and raised awareness about HIV in barber shops, clinics, general stores and elsewhere. The materials covered topics like appropriate condom use and awareness of HIV and other STIs. Ayyaz offers to provide further information and can be contacted at the email address provided.
Comparative Effectiveness: UCSF East Africa Global Health -Kisumu 2014GlobalResearchUCSF
The document describes an upcoming cost-effectiveness analysis workshop to be held in Kisumu, Kenya on January 20, 2014. The purpose of the workshop is to provide participants with a basic understanding of cost-effectiveness analysis concepts and methods and allow them to apply these concepts to an issue of their choosing. The workshop will cover core CEA approaches such as calculating incremental cost per standardized unit of health gain compared to alternative interventions and key metrics like the incremental cost-effectiveness ratio. The workshop aims to provide participants with a foundation for further developing CEA ideas and projects.
The document discusses compression stockings used to prevent deep vein thrombosis (DVT) during flights. It notes that in trials, stockings were below-knee compression of 10-30 mm Hg strength. It emphasizes proper fitting is important as stockings that are too tight can cut skin or prevent blood flow. It recommends wearing stockings before travel to ensure comfort and notes cost and availability can vary.
This document provides an overview of cost-benefit analysis as an economic evaluation technique. It discusses key aspects of CBA including:
- Measuring both costs and benefits in monetary terms, with an intervention undertaken if benefits exceed costs.
- Perspectives taken including patient, provider, and societal.
- Methods for measuring costs such as direct, indirect, and intangible costs.
- Methods for measuring monetary value of benefits including cost of illness averted and contingent valuation using willingness to pay.
- An example cost-benefit analysis of interventions to reduce cholera cases in an area.
This document discusses economic evaluation in healthcare decision making. It defines economic evaluation as using scientific methods to compare costs and benefits of alternative interventions. The main types of economic evaluation are described as cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, and cost-minimization analysis. The document outlines the generic steps in economic evaluation including defining the question, identifying and valuing costs and benefits, analyzing costs and benefits, and determining decision rules based on incremental cost-effectiveness ratios. Limitations of economic evaluation for resource allocation are discussed, noting that many factors beyond cost-effectiveness play a role in funding decisions.
Economic evaluations in clinical research compare the costs and health outcomes of interventions to determine value. They are increasingly important as healthcare spending rises. Common methods include cost-effectiveness analysis, which calculates cost per health outcome gained, and cost-utility analysis, which measures cost per quality-adjusted life year. However, economic evaluations face challenges in standardizing costs and accounting for factors like inflation over time.
This clinical guideline discusses the importance of providing high-value healthcare by evaluating the benefits, harms, and costs of medical interventions. It outlines three key concepts: 1) Assessing the benefits, harms, and costs of interventions is essential to understand their value. 2) The cost of an intervention should include downstream costs. 3) The incremental cost-effectiveness ratio estimates the additional cost required to gain more health benefits and provides a measure of an intervention's value. Evaluating value can help identify care that provides no benefit or may be harmful, as well as care that provides good value relative to its costs.
This document provides an overview of cost modeling and cost-effectiveness analysis. It discusses why these analyses are important, distinguishing between costs and charges and efficacy versus effectiveness. It also covers defining value, common study types like cost-effectiveness analysis and cost-utility analysis, and ways to communicate results such as using an incremental cost-effectiveness ratio and evidence rating matrix. Decision-analytic modeling is presented as a key approach to extrapolate short-term results to long-term outcomes.
Zeeshan Ayyaz of Amitiel Welfare Society in Bahawalpur, Pakistan thanks UNAIDS for HIV awareness and prevention materials. He distributed these materials and raised awareness about HIV in barber shops, clinics, general stores and elsewhere. The materials covered topics like appropriate condom use and awareness of HIV and other STIs. Ayyaz offers to provide further information and can be contacted at the email address provided.
ILC-UK and the Actuarial Profession Debate: The Economics of Promoting Person...ILC- UK
ILC-UK is delighted to be working with Alliance Boots and the University College London School of Pharmacy to explore why public health has just got ‘personal’ and if such a trend will yield cost savings or cost some groups of society or sections of the economy more than others.
The event will also mark the launch of a report produced by Professor David Taylor and Dr Jennifer Gill from the UCL School of Pharmacy, supported by Alliance Boots entitled ‘Active Ageing: Live longer and prosper? Towards realising a second demographic dividend in 21st century Europe’.
The debate will focus on the balance between encouraging individual accountability and accepting collective responsibility for achieving longer lives and the consequent implications for health outcomes and cost.
The Coalition Government (like its predecessors) is trying to move away from the ‘nanny state’ towards ‘nudging’ people in the direction of choosing healthier behaviours.
Few people would question the desirability of encouraging more informed personal decision making to prevent avoidable illness. But too much reliance on individual choice and responsibility could fail those most at risk and potentially impose needless costs and losses on individuals, their families and the wider community. Promoting the behavioural and cultural changes needed to deliver better public health and keep NHS and social care costs as affordable as possible remains a pressing and complex challenge.
Subject areas to discuss will include:
The philosophical and political underpinnings of public health policy, including: social solidarity, fairness, entitlement, risk and personal responsibility. Are we in danger of unravelling the principle tenets of the Beveridge model welfare state in ways which may not only disadvantage the most vulnerable, but may in time increase financial pressures on other sectors of society?
Determining the boundaries of personal and societal level responsibility, and the legitimate as opposed to illegitimate need for publicly funded care and support. In areas ranging from smoking cessation to reducing the threat of an obesity driven diabetes epidemic, communities have to make tough choices between limiting risks and accepting the consequences of personal, social and corporate freedom.
The impact of current trends and possible future policy decisions in areas ranging from the costs of health and life insurance to the price of pensions for individuals and society.
The role of private employers in promoting and requiring healthy living.
The winners and losers if the trend towards personal responsibility continues, with particular regard to older people and disadvantaged groups and what impact could this trend have on the cost of care?
Agenda from the event
16:00
Registration
16:30
Welcome, Baroness Sally Greengross
16:40 – 18:25
Presentations and responses from:
Prof. David Taylor
Prof. Nick Bosaonquet
Tricia Kennerley
Martin Green
The National Nutrition Policy of Nepal from 2004 aims to improve nutrition nationwide by reducing malnutrition rates. The key objectives are reducing protein-energy malnutrition, anemia, iodine deficiency, vitamin A deficiency, and intestinal worm infestation among children and women. The policy outlines strategies like community participation, advocacy, research, and multi-sector coordination to achieve its overall goal of ensuring nutritional well-being for all Nepalis. While programs have scaled up infant and young child feeding, coverage of interventions remains low and nutrition surveys need to be conducted more routinely. Strengthening food security and fully implementing breastfeeding recommendations could help address remaining weaknesses in Nepal's efforts to improve public health through nutrition.
This document provides an overview of tobacco use and counseling in India. It discusses the various types of tobacco used in India including smoked forms like beedis, cigarettes, and hookah as well as smokeless forms like khaini, gutkha, paan, and mishri. It outlines the constituents of tobacco that are linked to health risks like cancer. It also discusses the prevalence of tobacco use in India, the health effects of tobacco, and methods for quitting tobacco and providing counseling to patients.
Hiv &ictc seminar by Dr. Mousumi Sarkarmrikara185
India's national adult HIV prevalence is estimated at 0.26%. The total number of people living with HIV in India is estimated to be 21.17 lakhs. India has one of the world's largest HIV surveillance systems which helps monitor trends, levels, and burden of HIV among different populations. This system includes sentinel surveillance at antenatal clinics, Integrated Biological and Behavioural Surveillance among high-risk groups, sexually transmitted infection surveillance, AIDS case reporting, and death registration. The surveillance data is used to estimate disease distribution, identify groups for intervention, evaluate program effectiveness, and guide prevention efforts.
This document discusses bias in sampling and surveys. It defines random sampling as giving every population element an equal chance of being selected, making it an unbiased sample. Bias can occur if the sample is not representative, the survey is ambiguous or subjective, or factors influence responses. Types of bias include sampling bias, non-response bias, response bias, household bias, and measurement bias. Examples are given to illustrate each type of bias.
Operation research is a type of research that produces practically usable information to improve the effectiveness and efficiency of program implementation. While important for decision making, operation research is not widely used in the health sector due to a lack of people with engineering/mathematical backgrounds, a focus on specialized topics rather than healthcare, and a lack of data and expertise. Operation research can be applied at any step of the health program cycle, using either secondary data or primary data collection. There are four main types of operation research studies - exploratory, intervention, evaluation, and cost effectiveness - and it can help with issues like bed allocation, appointment scheduling, queue management, and project planning.
This document provides information about life expectancy in different countries according to WHO reports from 2011 and 2009. It also includes quotes from famous individuals about living to 100 years old. The rest of the document discusses the history and methodology of life tables, including how Edmond Halley constructed one of the first life tables over 300 years ago to analyze mortality data. Life tables are used to calculate various demographic indicators like life expectancy, survival rates, and population projections by age. While an older statistical tool, life tables continue to be useful for government and healthcare planning.
The document discusses zoonoses, which are diseases that can be transmitted between animals and humans. It provides definitions of zoonoses and describes how they have been classified based on their reservoir hosts and life cycles. Over 150 zoonotic diseases are known, and many emerged recently like Kyasanur Forest disease and Monkeypox. Zoonoses cause health issues and economic losses. Developing countries are often more severely impacted due to factors like climate and lack of public health/veterinary services. Common zoonotic diseases are described along with the specimens, tests, and methods used for laboratory diagnosis of bacterial, viral, rickettsial, parasitic and fungal zoonoses.
XNN001 Introductory epidemiological concepts - sampling, bias and errorramseyr
1. The document discusses key concepts in epidemiological sampling including different sampling methods such as probability and non-probability sampling.
2. It describes specific sampling techniques like simple random sampling, stratified sampling, cluster sampling, and their advantages and limitations.
3. The document also discusses potential sources of bias and error in epidemiological studies from sampling, data collection and analysis that can influence the validity and reliability of findings.
The document discusses India's growing burden of non-communicable diseases like cardiovascular diseases, cancer, diabetes, and stroke. It outlines the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) which aims to integrate NCD interventions into primary healthcare and provide prevention, early diagnosis, management and capacity building services. The strategies proposed include prevention through behavior change, early diagnosis, treatment, capacity building, and monitoring and evaluation. Services will be provided at sub-centers, community health centers and district hospitals, including health promotion, screening, management, home-based care and referrals.
The Integrated Disease Surveillance Project (IDSP) is a decentralized, state-based project that aims to establish a disease surveillance system for timely public health action. It integrates disease surveillance at state and district levels, improves laboratory support, and provides training. The IDSP oversees surveillance of diseases like malaria, diarrhea, tuberculosis, measles, and more. It has a strong organizational structure from the national to district levels to monitor diseases and respond to outbreaks. The IDSP reporting system utilizes forms to report suspect, probable and confirmed disease cases weekly from health centers to the state and national levels.
National population policies aim to influence demographic variables like fertility, mortality, and migration through coordinated laws and programs. India's 2000 population policy had immediate objectives to address health care needs, medium-term goals to reduce the total fertility rate to replacement level by 2010, and long-term aims to achieve stable population growth by 2045. Key programs implemented include the National Rural Health Mission and policies on family planning, maternal and child health, and population research. While progress has been made, more efforts are needed to accelerate declines in health indicators to meet policy targets.
1. It is important to be prepared for disasters by knowing the risks in your area and having an emergency plan. This includes learning evacuation routes and identifying shelter locations.
2. Your emergency plan should include how to contact family members and reconnect if separated. Designate an out-of-area contact since local networks may be down.
3. Prepare emergency kits with necessities like food, water and first aid supplies. Make sure to consider any special needs of family members like children, elderly or disabled individuals. Also prepare for pets.
The National Cancer Control Programme aims to control cancer in India through primary prevention, early detection, treatment, and palliative care. Key goals include preventing cancers caused by tobacco, screening and diagnosing cervical and breast cancers early, strengthening cancer treatment facilities, and providing palliative care. Over 8-9 lakh new cancer cases occur annually in India. The programme supports 27 Regional Cancer Centers, has developed oncology wings in 82 medical institutions, and runs 28 District Cancer Control Programmes.
The document discusses various topics related to contraception including:
1. Temporary contraceptive methods like pills, patches, rings, and injections act by stopping ovulation and thickening cervical mucus. They come in various hormone formulations and dosages.
2. Long-acting reversible contraceptives like IUDs and implants can provide contraception for years. IUDs with progestins can suppress ovulation while implants release progestins to thicken cervical mucus.
3. Other methods discussed include vaginal microbicides, tubal occlusion procedures, and emerging male contraceptives that aim to suppress sperm production.
The document provides a high-level overview of many common reversible contraceptive options,
Cancer is a leading cause of death worldwide, accounting for 12% of deaths globally. In 2008 there were an estimated 12.7 million new cancer cases and 7.6 million cancer deaths. The global cancer burden is expected to nearly double by 2030. Tobacco use is responsible for approximately 50% of cancer deaths. Other major risk factors include diet, infections, environmental exposures, and genetic factors. Prevention strategies focus on reducing tobacco use, promoting healthy diets, vaccinations, and screening programs. Treatment options include surgery, chemotherapy, radiation therapy, immunotherapy and stem cell transplantation.
Sampling errors occur when using a sample to make inferences about a population. There are two main types of sampling errors - random sampling error and bias sampling error. Random sampling error is caused by chance fluctuations in who is selected in the sample and usually balances out, while bias sampling error results from flaws in the sampling design or implementation and does not balance out. Some factors that influence the size of sampling errors are the sample size, with larger samples having smaller errors, and the heterogeneity of the population. Non-sampling errors also exist, such as errors in defining the population, sampling methodology, non-responses, and measurement errors.
The National Nutrition Policy adopted in 1993 aims to eradicate malnutrition in India through a multi-sectoral strategy. It utilizes direct short-term interventions like expanding nutrition programs for vulnerable groups and food fortification. Indirect long-term interventions include ensuring food security, improving purchasing power through employment generation, promoting small businesses, and nutrition education. The policy is implemented through inter-sectoral coordination at all levels of government and regular nutrition monitoring is carried out by the National Nutrition Monitoring Bureau.
An introduction to using cost-effectiveness analysis to inform spending decis...Carmen Figueroa
This document provides an introduction to using cost-effectiveness analysis to inform spending decisions on HIV testing. It discusses how economic evaluation considers both the health outcomes and costs of interventions to determine whether one intervention provides better value for money compared to alternatives. It outlines different types of economic evaluation and how they incorporate costs and outcomes. Health outcomes can be measured generically using QALYs or DALYs, or through disease-specific measures. Economic evaluations are typically conducted through modeling or alongside clinical trials. The results can help decision-makers compare interventions and maximize health given limited budgets.
This document provides an introduction to economic and cost-effectiveness analyses in healthcare. It outlines four main types of analyses: cost minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. For each type of analysis, it describes how costs and health outcomes are considered. It also discusses important aspects like perspective, time frame, discounting, estimating costs, and identifying health outcomes. The goal is to help learners understand why economic analyses are relevant for health policy and research decisions.
ILC-UK and the Actuarial Profession Debate: The Economics of Promoting Person...ILC- UK
ILC-UK is delighted to be working with Alliance Boots and the University College London School of Pharmacy to explore why public health has just got ‘personal’ and if such a trend will yield cost savings or cost some groups of society or sections of the economy more than others.
The event will also mark the launch of a report produced by Professor David Taylor and Dr Jennifer Gill from the UCL School of Pharmacy, supported by Alliance Boots entitled ‘Active Ageing: Live longer and prosper? Towards realising a second demographic dividend in 21st century Europe’.
The debate will focus on the balance between encouraging individual accountability and accepting collective responsibility for achieving longer lives and the consequent implications for health outcomes and cost.
The Coalition Government (like its predecessors) is trying to move away from the ‘nanny state’ towards ‘nudging’ people in the direction of choosing healthier behaviours.
Few people would question the desirability of encouraging more informed personal decision making to prevent avoidable illness. But too much reliance on individual choice and responsibility could fail those most at risk and potentially impose needless costs and losses on individuals, their families and the wider community. Promoting the behavioural and cultural changes needed to deliver better public health and keep NHS and social care costs as affordable as possible remains a pressing and complex challenge.
Subject areas to discuss will include:
The philosophical and political underpinnings of public health policy, including: social solidarity, fairness, entitlement, risk and personal responsibility. Are we in danger of unravelling the principle tenets of the Beveridge model welfare state in ways which may not only disadvantage the most vulnerable, but may in time increase financial pressures on other sectors of society?
Determining the boundaries of personal and societal level responsibility, and the legitimate as opposed to illegitimate need for publicly funded care and support. In areas ranging from smoking cessation to reducing the threat of an obesity driven diabetes epidemic, communities have to make tough choices between limiting risks and accepting the consequences of personal, social and corporate freedom.
The impact of current trends and possible future policy decisions in areas ranging from the costs of health and life insurance to the price of pensions for individuals and society.
The role of private employers in promoting and requiring healthy living.
The winners and losers if the trend towards personal responsibility continues, with particular regard to older people and disadvantaged groups and what impact could this trend have on the cost of care?
Agenda from the event
16:00
Registration
16:30
Welcome, Baroness Sally Greengross
16:40 – 18:25
Presentations and responses from:
Prof. David Taylor
Prof. Nick Bosaonquet
Tricia Kennerley
Martin Green
The National Nutrition Policy of Nepal from 2004 aims to improve nutrition nationwide by reducing malnutrition rates. The key objectives are reducing protein-energy malnutrition, anemia, iodine deficiency, vitamin A deficiency, and intestinal worm infestation among children and women. The policy outlines strategies like community participation, advocacy, research, and multi-sector coordination to achieve its overall goal of ensuring nutritional well-being for all Nepalis. While programs have scaled up infant and young child feeding, coverage of interventions remains low and nutrition surveys need to be conducted more routinely. Strengthening food security and fully implementing breastfeeding recommendations could help address remaining weaknesses in Nepal's efforts to improve public health through nutrition.
This document provides an overview of tobacco use and counseling in India. It discusses the various types of tobacco used in India including smoked forms like beedis, cigarettes, and hookah as well as smokeless forms like khaini, gutkha, paan, and mishri. It outlines the constituents of tobacco that are linked to health risks like cancer. It also discusses the prevalence of tobacco use in India, the health effects of tobacco, and methods for quitting tobacco and providing counseling to patients.
Hiv &ictc seminar by Dr. Mousumi Sarkarmrikara185
India's national adult HIV prevalence is estimated at 0.26%. The total number of people living with HIV in India is estimated to be 21.17 lakhs. India has one of the world's largest HIV surveillance systems which helps monitor trends, levels, and burden of HIV among different populations. This system includes sentinel surveillance at antenatal clinics, Integrated Biological and Behavioural Surveillance among high-risk groups, sexually transmitted infection surveillance, AIDS case reporting, and death registration. The surveillance data is used to estimate disease distribution, identify groups for intervention, evaluate program effectiveness, and guide prevention efforts.
This document discusses bias in sampling and surveys. It defines random sampling as giving every population element an equal chance of being selected, making it an unbiased sample. Bias can occur if the sample is not representative, the survey is ambiguous or subjective, or factors influence responses. Types of bias include sampling bias, non-response bias, response bias, household bias, and measurement bias. Examples are given to illustrate each type of bias.
Operation research is a type of research that produces practically usable information to improve the effectiveness and efficiency of program implementation. While important for decision making, operation research is not widely used in the health sector due to a lack of people with engineering/mathematical backgrounds, a focus on specialized topics rather than healthcare, and a lack of data and expertise. Operation research can be applied at any step of the health program cycle, using either secondary data or primary data collection. There are four main types of operation research studies - exploratory, intervention, evaluation, and cost effectiveness - and it can help with issues like bed allocation, appointment scheduling, queue management, and project planning.
This document provides information about life expectancy in different countries according to WHO reports from 2011 and 2009. It also includes quotes from famous individuals about living to 100 years old. The rest of the document discusses the history and methodology of life tables, including how Edmond Halley constructed one of the first life tables over 300 years ago to analyze mortality data. Life tables are used to calculate various demographic indicators like life expectancy, survival rates, and population projections by age. While an older statistical tool, life tables continue to be useful for government and healthcare planning.
The document discusses zoonoses, which are diseases that can be transmitted between animals and humans. It provides definitions of zoonoses and describes how they have been classified based on their reservoir hosts and life cycles. Over 150 zoonotic diseases are known, and many emerged recently like Kyasanur Forest disease and Monkeypox. Zoonoses cause health issues and economic losses. Developing countries are often more severely impacted due to factors like climate and lack of public health/veterinary services. Common zoonotic diseases are described along with the specimens, tests, and methods used for laboratory diagnosis of bacterial, viral, rickettsial, parasitic and fungal zoonoses.
XNN001 Introductory epidemiological concepts - sampling, bias and errorramseyr
1. The document discusses key concepts in epidemiological sampling including different sampling methods such as probability and non-probability sampling.
2. It describes specific sampling techniques like simple random sampling, stratified sampling, cluster sampling, and their advantages and limitations.
3. The document also discusses potential sources of bias and error in epidemiological studies from sampling, data collection and analysis that can influence the validity and reliability of findings.
The document discusses India's growing burden of non-communicable diseases like cardiovascular diseases, cancer, diabetes, and stroke. It outlines the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) which aims to integrate NCD interventions into primary healthcare and provide prevention, early diagnosis, management and capacity building services. The strategies proposed include prevention through behavior change, early diagnosis, treatment, capacity building, and monitoring and evaluation. Services will be provided at sub-centers, community health centers and district hospitals, including health promotion, screening, management, home-based care and referrals.
The Integrated Disease Surveillance Project (IDSP) is a decentralized, state-based project that aims to establish a disease surveillance system for timely public health action. It integrates disease surveillance at state and district levels, improves laboratory support, and provides training. The IDSP oversees surveillance of diseases like malaria, diarrhea, tuberculosis, measles, and more. It has a strong organizational structure from the national to district levels to monitor diseases and respond to outbreaks. The IDSP reporting system utilizes forms to report suspect, probable and confirmed disease cases weekly from health centers to the state and national levels.
National population policies aim to influence demographic variables like fertility, mortality, and migration through coordinated laws and programs. India's 2000 population policy had immediate objectives to address health care needs, medium-term goals to reduce the total fertility rate to replacement level by 2010, and long-term aims to achieve stable population growth by 2045. Key programs implemented include the National Rural Health Mission and policies on family planning, maternal and child health, and population research. While progress has been made, more efforts are needed to accelerate declines in health indicators to meet policy targets.
1. It is important to be prepared for disasters by knowing the risks in your area and having an emergency plan. This includes learning evacuation routes and identifying shelter locations.
2. Your emergency plan should include how to contact family members and reconnect if separated. Designate an out-of-area contact since local networks may be down.
3. Prepare emergency kits with necessities like food, water and first aid supplies. Make sure to consider any special needs of family members like children, elderly or disabled individuals. Also prepare for pets.
The National Cancer Control Programme aims to control cancer in India through primary prevention, early detection, treatment, and palliative care. Key goals include preventing cancers caused by tobacco, screening and diagnosing cervical and breast cancers early, strengthening cancer treatment facilities, and providing palliative care. Over 8-9 lakh new cancer cases occur annually in India. The programme supports 27 Regional Cancer Centers, has developed oncology wings in 82 medical institutions, and runs 28 District Cancer Control Programmes.
The document discusses various topics related to contraception including:
1. Temporary contraceptive methods like pills, patches, rings, and injections act by stopping ovulation and thickening cervical mucus. They come in various hormone formulations and dosages.
2. Long-acting reversible contraceptives like IUDs and implants can provide contraception for years. IUDs with progestins can suppress ovulation while implants release progestins to thicken cervical mucus.
3. Other methods discussed include vaginal microbicides, tubal occlusion procedures, and emerging male contraceptives that aim to suppress sperm production.
The document provides a high-level overview of many common reversible contraceptive options,
Cancer is a leading cause of death worldwide, accounting for 12% of deaths globally. In 2008 there were an estimated 12.7 million new cancer cases and 7.6 million cancer deaths. The global cancer burden is expected to nearly double by 2030. Tobacco use is responsible for approximately 50% of cancer deaths. Other major risk factors include diet, infections, environmental exposures, and genetic factors. Prevention strategies focus on reducing tobacco use, promoting healthy diets, vaccinations, and screening programs. Treatment options include surgery, chemotherapy, radiation therapy, immunotherapy and stem cell transplantation.
Sampling errors occur when using a sample to make inferences about a population. There are two main types of sampling errors - random sampling error and bias sampling error. Random sampling error is caused by chance fluctuations in who is selected in the sample and usually balances out, while bias sampling error results from flaws in the sampling design or implementation and does not balance out. Some factors that influence the size of sampling errors are the sample size, with larger samples having smaller errors, and the heterogeneity of the population. Non-sampling errors also exist, such as errors in defining the population, sampling methodology, non-responses, and measurement errors.
The National Nutrition Policy adopted in 1993 aims to eradicate malnutrition in India through a multi-sectoral strategy. It utilizes direct short-term interventions like expanding nutrition programs for vulnerable groups and food fortification. Indirect long-term interventions include ensuring food security, improving purchasing power through employment generation, promoting small businesses, and nutrition education. The policy is implemented through inter-sectoral coordination at all levels of government and regular nutrition monitoring is carried out by the National Nutrition Monitoring Bureau.
An introduction to using cost-effectiveness analysis to inform spending decis...Carmen Figueroa
This document provides an introduction to using cost-effectiveness analysis to inform spending decisions on HIV testing. It discusses how economic evaluation considers both the health outcomes and costs of interventions to determine whether one intervention provides better value for money compared to alternatives. It outlines different types of economic evaluation and how they incorporate costs and outcomes. Health outcomes can be measured generically using QALYs or DALYs, or through disease-specific measures. Economic evaluations are typically conducted through modeling or alongside clinical trials. The results can help decision-makers compare interventions and maximize health given limited budgets.
This document provides an introduction to economic and cost-effectiveness analyses in healthcare. It outlines four main types of analyses: cost minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. For each type of analysis, it describes how costs and health outcomes are considered. It also discusses important aspects like perspective, time frame, discounting, estimating costs, and identifying health outcomes. The goal is to help learners understand why economic analyses are relevant for health policy and research decisions.
Cost utility analysis (CUA) is a form of economic analysis that measures the quality and quantity of life generated by healthcare interventions. It measures outcomes in quality-adjusted life years (QALYs) which account for both the length of life and the quality of life for time lived. CUA allows comparison of different healthcare interventions by measuring their costs and outcomes using a single metric (QALYs), taking into account costs and health outcomes. It is used when quality of life is an important outcome or when interventions impact both mortality and morbidity.
This document defines pharmacoeconomics and describes pharmacoeconomic studies. It explains that pharmacoeconomics identifies, measures, and compares the costs and consequences of drug therapies. Pharmacoeconomic studies weigh the costs of alternative drugs against their outcomes to inform decisions. The key types of pharmacoeconomic studies - cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis - are outlined. Costs include direct medical costs, direct non-medical costs, and indirect costs. Outcomes can be measured in life-years or quality-adjusted life-years.
Economic evaluation involves comparing the costs and consequences of alternative courses of action to identify the most efficient way to achieve health objectives given scarce resources. It examines both the inputs (costs) and outputs (consequences) of programs. The main types of economic evaluation are cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. Economic evaluation is important because it provides an evidence-based framework to inform difficult decisions about how to allocate limited healthcare resources in a way that maximizes health benefits.
Here is the slide on Healthcare economic evaluation. The content of this presentation doesn't belong to me. They are copied from several literature and internet
Health economics is the discipline of economics applied to the topic of health care. Broadly defined, economics concerns how society allocates its resources among alternative uses. Health economics addresses questions primarily from the perspective of efficiency, maximising the benefits from available resources or ensuring benefits gained exceed benefits forgone. This presentation covers the concept, components, importance, factors influencing, steps and various types of evaluation in health economics.
Cost-utility analysis (CUA) is a type of economic analysis that compares treatment alternatives by integrating measures of patient preferences and health-related quality of life. CUA uses quality-adjusted life years (QALYs) as the measure of health outcome, which combines both quantity and quality of life into a single metric. The preferred treatment is the one with the lowest cost per QALY gained. QALYs are calculated by multiplying the expected survival time in a health state by a weight representing the quality of life in that health state on a scale of 0 to 1, with 0 being death and 1 being perfect health. CUA allows for comparison of interventions that impact both mortality and morbidity.
This document provides an overview of key concepts in health economics. It discusses how health economics studies how scarce resources are allocated for healthcare and how health and healthcare services are distributed. It defines equity and efficiency, and explains the importance of both. It also covers the concepts of demand and supply curves, and how bringing them together can lead to an efficient allocation of resources. Different types of economic evaluation techniques like cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis are introduced. The document provides examples of how these concepts can be applied through case studies.
This document discusses different types of costs that should be considered in an economic evaluation of a health care program or intervention. It describes direct costs, indirect costs, and intangible costs. It also discusses the different perspectives from which costs can be assessed, including costs to the health ministry, patients, and society. The document provides details on how to identify, measure, and value different cost items from each of these perspectives. It also defines and compares different types of economic evaluation that can be used including cost-effectiveness analysis, cost-minimization analysis, and cost-benefit analysis.
Economic evaluation is used to identify the best use of healthcare resources by comparing costs and outcomes of alternative programs. There are various types of economic evaluations including partial evaluations, which consider either only costs or outcomes, and full evaluations, which consider both costs and outcomes. Common full evaluations are cost-effectiveness analysis, which compares costs to health outcomes, cost-benefit analysis, which expresses both in monetary terms, and cost-utility analysis, which compares costs to quality-adjusted life years. The results of economic evaluations help inform difficult healthcare resource allocation decisions.
Pharmacological evaluation thay relate economic aspect withRemedan4
The document discusses cost-effectiveness analysis (CEA) as an economic evaluation method. CEA compares the costs of interventions to their outcomes, with outcomes expressed in natural units like lives saved rather than dollars. Key points made include:
- CEA ratios compare net costs to net effects of interventions. Multiple interventions affecting the same outcome can be compared incrementally.
- Outcomes are typically intermediate outcomes like cases prevented, but ideally more final outcomes. Quality-adjusted life years (QALYs) from cost-utility analysis combine length and quality of life.
- Utilities on a 0 to 1 scale quantify preferences for quality of life to derive QALYs. Standard gamble is the gold standard but rating scales are
This document discusses different types of economic evaluation methods used in public health decision making. It explains that economics considers the value of outcomes produced rather than just the distribution of outcomes. Scarce resources must be allocated to achieve maximum public health benefits. The key economic evaluation methods discussed are cost analysis, cost-effectiveness analysis, and cost-benefit analysis. It provides details on direct, indirect and intangible costs and how they are categorized. It also explains the differences between cost-effectiveness analysis and cost-benefit analysis, including how outcomes are measured and valued in each method.
Presentation by Paula Lorgelly - Beyond QALYs: A Quantum Leap Forward or a Le...Office of Health Economics
OHE’s Paula Lorgelly took part in the Future of Value: Insights from the Experts panel discussion, Indianapolis, on 1 March 2016.
Paula presented a paper which discusses issues with going 'beyond quality adjusted life years (QALYs)' when valuing health care interventions. There are three dimensions to consider when going beyond QALYs: develop a better measure of health (e.g. one that could be condition-specific); use broader measures of benefit; consider a societal perspective (e.g. include productivity loss and carers’ effects).
Paula’s presentation focused on utilising a broader measure of benefit, focusing on alternative such as the capability approach and subjective wellbeing measures.
The panel was sponsored by Eli Lilly.
This document discusses various pharmacoeconomic methods used to evaluate the costs and benefits of drug therapies including cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, cost-minimization analysis, and cost of illness studies. It provides details on how each method is conducted and examples of how they are applied. Cost-benefit analysis compares monetary costs of a drug to its health benefits, while cost-effectiveness analysis expresses health outcomes in units like lives saved rather than dollars. Cost-utility analysis uses quality-adjusted life years to incorporate both mortality and morbidity.
This document summarizes a presentation given by Adrian Towse on the topic of QALYs (Quality-Adjusted Life Years) and equity. It discusses different definitions of equity in healthcare, lessons from using QALYs to determine value-based pricing in England, ways to expand what is captured in healthcare decision-making beyond just QALYs, and applications of extended cost-effectiveness analysis in middle- and low-income countries. The presentation examines moving from listing factors that matter to patients and society to measuring and weighting them, and argues for a fair and deliberative decision-making process to determine healthcare priorities and resource allocation.
This document summarizes a presentation given by Adrian Towse on the topic of QALYs (Quality-Adjusted Life Years) and equity. It discusses different definitions of equity in healthcare, lessons from using QALYs to determine value-based pricing in England, ways to expand what is captured in healthcare decision-making beyond just QALYs, and applications of extended cost-effectiveness analysis in middle- and low-income countries. The presentation examines moving from listing factors that matter to patients and society to measuring and weighting them, and argues for a fair, deliberative decision-making process to determine healthcare priorities and resource allocation.
This document provides an overview of cost-utility analysis (CUA) as a form of pharmacoeconomic evaluation. It defines CUA and distinguishes it from cost-effectiveness analysis by noting that CUA compares outcomes in terms of quality-adjusted life years (QALYs). The document discusses how QALYs combine both survival time and health-related quality of life into a single metric. It also describes approaches to measuring health utility values and calculating QALYs. Finally, the document provides examples of when CUA would and would not be appropriate to use and outlines factors like incremental cost-utility ratios used to interpret CUA results.
This document provides an overview of health care cost concepts and economic evaluation. It defines key cost terms like total cost, fixed cost, variable cost, marginal cost, and opportunity cost. It also explains different methods of economic evaluation used to analyze health care costs and outcomes, including cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, and cost-minimization analysis. Quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs) are discussed as common measures used in cost-utility analysis to evaluate health outcomes.
This document discusses the economics of animal diseases through several modeling approaches. It begins by outlining how animal diseases can cost 10% of gross production and 40-50% of net income on farms. It then discusses various modeling techniques that can be used to study the economics, including simulation and optimization models. Specific examples are provided on partial budgeting, cost-benefit analysis, and decision tree analysis. The document also provides background on foot-and-mouth disease and describes an epidemic simulation model that was developed to evaluate control strategies for outbreaks.
Similar to Eupha 1.introductionby wernerbrouwer (20)
1. Economic evaluation in public health
A brief introduction of concepts, methods and decision rules
Werner Brouwer
Professor of Health Economics
Institute for Medical Technology Assessment &
Institute of Health Policy & Management
Erasmus University Rotterdam
3. Economics
• Economics is concerned with the efficiency (and equity) implications of the
allocation of scarce resources in society over alternative uses
• Equity and efficiency issues cannot be solved independently (Arrow, 1963)
• Core assumption: desires of individuals are infinite, yet are resources
limited.
• Scarcity: never enough resources to satisfy all human wants and needs
• Choices required to spent scarce resources ‘optimally’
• Optimal defined by the goal function: maximization of welfare / utility /
happiness (individuals), profit (firms), social utility (society) given constraints
• Here also scarcity of time: focus on economic evaluation!
4. Welfare economics is normative science
• Welfare economics is concerned with normatively judging a change (like
implementing some intervention), moving us from ‘state of the world’ A to B
• ‘In order to make statements about the consequences for economic welfare of
an event we must go beyond the study of positive economics, which is
concerned with the effects of an event on objectively measurable economic
variables, such as price and quantity. That is, the welfare economist wishes to
determine the desirability of a particular policy – not in terms of his or her own
values, but in terms of some explicitly stated ethical criteria’
(Boadway and Bruce, 1984, p.1).
• Social welfare normally deemed to be some aggregation of individual welfares
only (welfarism) - if social welfare increases a change is deemed desirable
• Measuring individual welfare difficult…
5. From Pareto to CBA
• Non comparability of utility gave rise to quite strict rules for optimality
• Pareto optimal allocation of goods and services in a society: no reallocation
possible in such a way that at least one person is better off and none is worse off.
• Very restrictive – avoided by expressing gains and losses in monetary terms
• Potential Pareto-optimality occurs when the (monetary) gains of the winners are
sufficient to compensate the loss of the losers (Kaldor & Hicks)
• That is nothing else than the foundation of economic evaluation in its purest form:
Cost Benefit Analysis
• (Compromise: we assume the utility value of all euros to be equal!)
• CBA: see whether the losses (costs) are outweighed by the gains (benefits) of
some change:
• vi * (Qi
B
– Qi
A
) – (CB
– CA
) > 0 vi*Δ Qi – ΔC > 0 vi*Δ Qi > ΔC
ΔC / Δ Qi < vi (don’t pay more per unit than the unit is worth)
6. Economic Evaluation in Health
new
health care
intervention
old
health care
intervention
Difference in
(value of) health
status after
intervention
Difference in
resources
consumed
Do the benefits, here defined as health (value) exceed the costs?
7. Economic Evaluation in Health
• Aim to aid decision makers in health care by providing them information on
the relative efficiency of programs in producing health (value)
• Provides information on all relevant costs and (value of) health gains of
different alternatives health care technologies (e.g. pharmaceuticals,
operating procedures, public health, etc)
• Main types of evaluations are:
– Cost-benefit analysis ($/$)
– Cost-effectiveness analysis ($/E) and the preferred
– Cost-utility analysis ($/QALY)
• Latter types are not full economic evaluations: they indicate only the
amount of health gained, not the value of health, i.e., such economic
evaluations focus on left-hand side only: ΔC / Δ Qi
• Broader framework: cost-consequence analysis
8. Perspective
• Given welfare economic roots of economic evaluation, it is often advocated to
adopt a societal perspective in performing them
• Indeed, only then one can assert that benefits outweigh costs
• “When a CEA is conducted from the societal perspective, the analyst considers
everyone affected by the intervention and counts all significant health outcomes
and costs that flow from it, regardless of who experiences the outcomes or costs’.
(Gold et al., 1996)
• E.g.: Quick discharge from hospital – may save costs for the hospital, or even
health care sector, but may require more informal care ; Cheap rest vs. expensive
drug – more absence from work makes rest less cheap…!
• Still, many countries take narrower perspective (often health care)
• Health care decision maker may work with some budget aimed to ‘optimize’ health
• Especially in field of public health broad perspective crucial
9. Counting all health gains: QALYs
• CBA often difficult, distrusted and considered ‘unethical’
• CEA makes coherent and consistent decision making difficult, given
incomparability of outcome measures
• CUA makes different health states / health gains comparable and facilitates
decisions
• Quality-Adjusted Life-Years: preference (utility) based health measure
• One year of life is more valuable (i.e. preferred over) when it is lived in perfect
health rather than sub-optimal health states
• It also recognises that non life-prolonging interventions may be worthwhile or
that some life-prolonging interventions are, in fact, not worth while
• Thus, it tries to assess the health state of people with certain conditions
(describing, measuring) but it also tries to value them in non monetary ways
10. QALYs
• QALY assigns a weight to health states,
• 1 represents one year in perfect health
• 0 represents one year in state ‘dead’
• Most health states in between 0 and 1 (some below 0)
• Different ways of deriving weights: TTO, SG, VAS
• Say weight of state A is 0.6 then moving someone from A
to perfect health for one year yields 0.4 QALY
• Doing this for 5 years equals a gain of 2 QALYs
(undiscounted)
• Information on effects of intervention ideally through RCT’s
etc
Worst imaginable health
X
Best imaginable health
11. Counting all costs
Intervention resources,
directly needed for the
intervention
Non-intervention resources
needed for the intervention
(e.g. travel)
Patient time including
productivity changes
Time of informal caregivers
and other costs of informal
care
I
N
T
E
R
V
E
N
T
I
O
N
Outcomes:
Improved
health
Future costs that are a
consequence of the
intervention
... ???
12. Some general, basic rules
• Count costs and effects relative to some other RELEVANT situation or
treatment (i.e. incrementally)
• Calculate effectiveness in a reliable way and take a sufficiently long time
horizon (often requires modeling)
• Include all relevant costs (three steps: identification, measurement and
valuation)
• Adjust costs and effects for the timing at which they occur (discounting)
• Look at uncertainty around estimates and be explicit about this (e.g. cost-
effectiveness plane and acceptability curves)
14. From CUA to decision: monetary value required
• The popularity of CUA stems partly from the fact that benefits are
expressed in terms of some health measure (like QALYs) and not in
money - but still one needs to decide whether some cost per QALY is
worthwhile (i.e. the v)
• Two possible approaches (all a bit simplified):
(1) take a fixed budget and implement programs with lowest cost per QALY
(2) add programs that have a cost per QALY below some threshold value
(threshold in theory should equal social value of a QALY): ΔC / Δ Qi < vi
• Opportunity costs either occur within the health care sector (fixed budget:
health for health) or outside the health care sector (flexible budget: wealth
for health)
15. Intervention $ / QALY
GM-CSF elderly with leukemia $235.958
EPO in dialysis patients $139.623
Lung transplantation $100.957
End stage renal disease $53.513
Heart transplantation $46.775
Didronel in osteoporosis $32.047
Statins in high cholesterol $18.151
PTA with Stent $17.889
terbinafine in onychomycosis $16.843
Breast cancer screening $5.147
Viagra $5.097
Congenital anorectal malformation $2.778
Some results
16. What’s the problem?
• Value of a QALY appears to vary with the characteristics of the disease and / or
beneficiary in health (and perhaps other) terms
• QALY maximization as a goal seems imprecise and attaching equal value to all
QALY gains may not be considered ‘equitable’
• Many factors may influence value (e.g. Dolan et al, 2005): normative vs. positive…
• Equity weights can be seen simply as relative social values (v1/ v2 = α), where α is
the relative weight of type 1 compared to 2
• There seems to be a broad range of vi’s attached to relevant QALYi’s
• A varying threshold is required? vi rather than v
• Normative choices regarding with what the threshold should vary!
• In the Netherlands: severity of illness (measured as proportion of health foregone)
• In UK: NICE uses range and allows ‘equity’ weights for end of life drugs
17. Flexible threshold – the Dutch case
0
20000
40000
60000
80000
0 20% 40% 60% 80% 100%
Severity of illness
CostsperQALY
Threshold
18. Some attention points in public health
• Demonstrating effectiveness can be difficult
• QALYs only or most relevant outcomes?
• Certain costs important (e.g. time costs) but difficult to value
• Costs in other sectors need to be captured
• How to weight future health effects (discounting)
• Inclusion equity may be difficult
• Perceived necessity sometimes low: statistical versus identifiable lives
• However, important that public health interventions demonstrate value for
money!
Editor's Notes
Mijnheer de Rector Magnificus,
zeer gewaardeerde toehoorders,
Bent u ook zo gespannen?
Voor morgen, bedoel ik dan natuurlijk.
Morgen is het namelijk weer zo ver.
Pakjesavond!
Dan weet u weer wat de goedheilig man uit Spanje dit jaar voor u heeft meegebracht!
&lt;KLIK&gt;
If we can represent the relevant decision rule on the CE plane by a line with positive slope equal to the ceiling ratio (the maximum cost per unit of effect that a decision-maker is prepared to pay) then we have effectively divided the CE plane into two halves. Interventions with a cost/effect pairing falling to the left of the line are deemed cost-ineffective, while interventions with a cost-effect pairing falling to the right of the line represent good value for money.
This representation of the cost-effectiveness plane as falling into two-halves (rather than into four quadrants) will become important when we discuss the limitations of confidence intervals for CE ratios.
Naarmate de onderliggende aandoening meer proportioneel gezondheidsverlies veroorzaakt, mag de kosteneffectiviteit van de bijbehorende interventies minder gunstig zijn.
Rechtvaardigheid en doelmatigheid worden hier aan elkaar verbonden middels de prijs die voor een QALY willen betalen. De waarde van de QALY loopt op met noodzakelijkheid.
Oftewel: de claim op financiële solidariteit mag groter zijn naarmate de onderliggende ziekte ernstiger is.
Over waar de grenslijn precies loopt zegt het CVZ niet zoveel.
Er wordt alleen aangegeven dat de grens loopt van ongeveer 10.000 euro voor een beperkte ziektelast tot ongeveer 80.000 euro voor een zeer ernstige ziektelast.
Ik heb als illustratie deze lijn dus maar even getrokken, maar ik had hem ook anders kunnen tekenen.
KLIK
Bij deze lijn valt de interventie voor lage rugklachten nog net binnen de veilige zone en dus binnen het basispakket.
Viagra en kalknagelmedicatie vallen er buiten. Zij zijn wel doelmatig maar niet heel erg noodzakelijk.
Ze daarmee liggen boven de drempellijn, ongeveer hier
KLIK,
Maar bijvoorbeeld longtransplantaties vallen er binnen.
De relatief hoge kosten per QALY zijn acceptabel vanwege de hoge noodzaak tot ingrijpen.
Longtransplantaties vallen daarmee ongeveer hier
KLIK
Zo kan dus worden bepaald wat er wel en wat er niet in het basispakket thuishoort.
&lt;KLIK&gt;