At the 2021 GACD Annual Scientific Meeting, researchers, implementing partners, and funders met in communities of practice to explore cross-cutting issues.
A community of practice shares knowledge and experience, so that everyone taking part can advance their own and each other’s knowledge. By exchanging stories, problems, and solutions, the community of practice brings collective knowledge to key issues.
During Day 2’s community of practice session, our expert co-leads, Helen Weatherly, Kavita Singh, and Guillermo Paraje, introduced participants to the principles and utility of health economics.
In Part 2 of our blog series on the ‘science of scarcity’, we highlight the knowledge exchanged while discussing Kavita’s case study on cost effectiveness.
Kavita presented her work on a cost-effectiveness evaluation of a multicomponent diabetes care model in South Asia. Her analysis demonstrated that simple, inexpensive evidence-based tools and task-shifting could quickly and effectively improve diabetes care.
How did Kavita’s team apply health economic techniques?
The health economic-specific research questions the team asked were: Is the intensive, multifactorial care package (with a care coordinator and decision support system) more cost effective than standard care in…
…achieving multiple risk factor control for diabetes patients in India?
…avoiding major diabetes-related complications for diabetes patients in India?
…avoiding mortality in productive age ranges (life years gained before age 65) for diabetes patients in India?
…improving quality of life and treatment satisfaction?
Kavita and her team used a framework for developing their economic evaluation, identifying the objectives of analysis, the audience of the evaluation, the perspective of the analysis, the analytic horizon (time), the intervention, comparator, target population, and type of analysis.
The steps take were as follows:
Quantify the health outcomes (examples from Kavita’s project included mean change in HbA1c, blood pressure, and LDLc; proportion of participants achieving multiple risk factor control; health-related quality of life.)
Quantify the associated costs (examples from Kavita’s project included direct costs, such as physician’s time, medications, medical supplies, laboratory tests; indirect costs, such as adverse event count, days missed from work for outpatient visits, income loss of participant due to outpatient visits.)
Assess whether and how much the costs vs outcomes differ between alternatives (examples from Kavita’s project included inputs = resources required for the intervention and concomitant values (costs); outputs = the effects of treatment (benefit versus harm) and concomitant values.)
Compare the magnitude of differences (examples from Kavita’s project included estimated ICER for incremental cost per percentage reduction in multiple risk factors; Markov modelling associating changes in HbA1c, blood pressure, and LDLc on long-term event rates.)
Address the sources of uncertainty (examples from Kavita’s project included ongoing analysis.)
Kavita noted that further research is needed to determine whether the cost-effectiveness observed persists over a longer time period for robust outcome measures, such as QALYs gained. The full methods and results are in press.
Discussion prompts
What are the issues and priority areas for the use of health economics to evaluate NCD programmes?
What are the main considerations for transferability of economic evaluation findings from high income settings to low- and middle-income settings?
Read other parts of this blog series: Part 1 and Part 3.
More resources
Visit the Global Health Economics Forum.
Explore the GACD Implementation Science e-Hub.