Economic Evaluation of the Public Health
Introduction
The economic evaluation of the public health intervention reflecting the health intervention process is chosen in the assessment. Complexity in the public health intervention system has been evaluated by the critical checklist preparation appraisal system. The effectiveness and the cost effectiveness are described in this complex health intervention procedure of the community. The module of the public health economy is developed and the change behavior for preventing disease is reflected in this assignment. The area for primary prevention is selected as the area of diabetes increment among the Asian Indians and the prevention program is evaluated.
Reflection to the Module
While reflecting on “public health economics”, I have evaluated that decision-making is important so that society can utilise available resources for mitigating objectives of health interventions as well as minimising opportunity expenses. Hence, I have understood that evaluation of health interventions can help to prevent diseases, creating threats in a cost-effectiveness context.
Question 1
A critical appraisal of the economic evaluation of the complex public health intervention you have chosen using a critical appraisal checklist for economic evaluation
Critical appraisal has been done regarding economic evaluation in complicated health interventions with help of an appraisal checklist, propounded by Evers et al. through following factors-
Clear description of a population
A clear description has not been given in this article in which the research has been performed; however, this study only focused on overall improvement regarding aggregate population’s health. As stated by Kelly et al. (2005), interventions of public health often demand an alteration in behavioural patterns of population for ensuring intervention uptake. Despite selecting a particular population with specific treatment necessities or regional contexts, this research concentrated on reduction of health inequalities in overall population. This article considered interventions of public health in local authorities, education, and workplace and transport sectors, despite describing a specific population.
Competing alternatives
Despite considering population measures, competing alternatives of individual measures have been discussed. However, Michie et al. (2018) argued and opined that in purpose for pragmatic reasons, public health appraisals can be conducted frequently from NHS (“National Healthcare Services”) along with alternative agencies of public sector. Either benefits or costs are varying between procedures of treatment.
Well-defined question of research in an answerable form
This research has posed a question regarding public health interventions’ economic appraisal in a specific answerable form. In order to find the answer to this question, this article has discussed health determinants along with health inequalities, relationship between downstream and upstream interventions, mediating roles regarding behavioural change (Kelly et al. 2005). Furthermore, social along with biological variation and separating effects and causes have been highlighted. Despite only raising the question regarding an economic appraisal, the answerable form has been given as the solution.
This study has emphasised multiple evaluation methods and preferred individual intervention’s evaluation in comparison to complex programs of public health. As propounded by Lacerenza et al. (2018), analysis of cost-minimisation can extend economic analysis through considering alternative resource usage. This research study has discussed that ell-conducted analysis of cost minimisation can help to evaluate the cost-effectiveness of health intervention. On other hand, to find out cost-effectiveness, this study prioritised importance of “cost-offset study” that is involved in comparing costs that are incurred with cost savings.
Stated objective
Objectives of this research have been clearly stated to analyse difficulties in economic appraisal regarding interventions of public health. Furthermore, specified research has considered objective to discuss problems in application of economic evaluation in interventions of public health.
Appropriateness of relevant consequences and costs
The selected time horizon is appropriate for inclusion of relevant consequences and costs. This research has emphasised programs of public health on a long-term basis. Furthermore, this study has agreed that final results of such interventions can take one year or several years. Hence, under these circumstances, it is challenging to attribute to a single specific intervention. In such cases, this research has recommended retrospective analysis or utilising secondary data.
Actual perspective of the study
Studies on health economics provide relevant information to policymakers so that available resources can be properly used to maximise health benefits (Holt-Lunstad et al. 2017). In this context, the actual perspective has been chosen appropriately as this research has contributed to economic evaluation so that decision-makers can effectively compare costs as well as consequences of health interventions. For this purpose, this research has shed light on multiple approaches or methods in purpose of analysing cost-effectiveness-
- Cost-effectiveness analysis
- CCA or “cost–consequence analysis”
- Measures of Cost–utility analysis
- CBA or Cost–benefit analysis
These measures have been elaborated along with their benefits by securing actual perspective of this study.
As per the article by Kelly et al. (2017), the economic appraisal of these public health interventions is not only underdeveloped but also intrinsically difficult. There is a significant relationship between the upstream as well as downstream public health interventions. On one hand, the target of the upstream intervention is to create a particular circumstance where adverse health behaviours are prepared (Blanchet et al. 2017). On the other hand, the main target of the downstream interventions is to change the behaviours regarding adverse health. In order to be effective as well as cost-effective, the public interventions need a change in the behaviour patterns of an individual as well as a community to make sure that they are up-taking the intervention. The change of behaviour that takes place is an intermediate event that is very crucial in order to reach the final outcome.
There is no particular standard as well as a method that can actually measure the effectiveness of a particular health intervention. However, ‘common currency outcome measures’ is used by organisations in order to measure the cost per quality-adjusted life-year that can help to evaluate the effectiveness of public health intervention with a careful assessment. As stated by Ismail et al. (2017), there are many estimates that that has been evaluated to date to show that there is a favourable comparison between public health interventions and treatment interventions. On the basis of this particular article, it can be said that the actual mechanisms of economic appraisal are needed to be applied to the public health interventions. In addition to that, there is a need for the economic appraisal to be lined with the appraisal of the effectiveness.
Moreover, the economic evaluations are needed to be completed in a proper routine and are considered as a consistent part of each and every public health intervention. An economic framework that is quite common is also needed to be used by the economic evaluation that would facilitate as well as enhance a transparent and consistent basis in order to make decisions. Furthermore, this particular analysis is needed to retain the feel as well as the shape of an old or conventional economic framework (Lopez Bernal et al. 2018). On the other hand, it will need a sufficient amount of flexibility that will help it to capture a complex, layered as well as the multi-dimensional outcome of the policies as well as interventions regarding public health.
In addition to that, in order to make an economic appraisal, the analysis is required to be able to inform if any kind of evaluation regarding the effectiveness as well as cost-effectiveness of the interventions take place. Therefore, these interventions will be able to reduce any kind of inequalities that can be observed in health. On the basis of the chosen article Kelly et al. (2005), CBA (cost-benefit analysis), as well as CCA (cost–consequence analysis) methods, are the ones that have been proved quite helpful in order to capture the effectiveness of this particular public health intervention.
Future costs and outcomes
The future outcomes and the costs for the public health intervention program can be recognised as the reflection in the three year trial period. The cost can be saved in the future and the intervention can develop a huge productivity as the outcomes. The future cost can be impacted by the taxation process and the future medical care costs can be avoided and productivity can be lost without proper intervention (Adedeji, 2019). The data of extrapolate can be used in the given model for the increment of the investment in the process. Public health intervention can help to reduce the high costs developed in for the hiring of the physicians and the training programs for the healthcares. The quality of the outputs and outcomes can be different and separate for the public sector intervention process. The procedure is relevant and the outcomes of the research for changing behaviours and attitudes can occur implementing the intervention system.
Consideration
The intervention of the public health can develop the outcomes and the outputs for the level of the target in the reference case. Therefore outputs and outcomes cannot be produced or the process can be referred as the deadweight in the system. Deadweight can be reflected assuming the proportion of the entire gross effect of additional process under the reference cases.
Sensitivity analysis
The effect can be analysed varying the key assumptions for the sensitivity test in the system and the process can be linked with the key drivers of the market. The risks assessment process for the project and the programme can be developed in the process for monitoring the details.
Conclusions following the data reported
The data projected in the document has identified a lot of issues which can be addressed in the intervention system in additional way with correct process. This system can be assessed developing the cases in references and the benefits can be identified in this system possible maximise way (Callahan et al. 2019). The effect of the scale including the quality and the outcomes are developed which is important for the intervention resulting in different quality.
Results
The real result can be delivered from the efficient public health intervention and the effective process. The procedure can be taken place in the result for the intervention developing the target group and the procedure can be used (Besnier et al. 2018).
Conflict of interest
The study has not developed any interest or conflict regarding the issues and the cost effective process by the public health intervention process in the disease in the areas of India (Byhoff et al. 2018). Therefore, the study has developed the ideas in a proper and transparent way according to provide the benefit to the public.
Ethical consideration
The study has developed the ideas and knowledge in an ethical way reflecting the issues and the consideration for the public health intervention system.
Question 2
Evaluation of the effectiveness and cost-effectiveness of complex public health interventions in the community
The analysis of cost-effectiveness is one of the ways that are used in order to analyse the health outcomes as well as the costs of a particular intervention. In addition to that, it also compares the outcomes of a particular intervention to the outcomes of another intervention. It can be done by estimating how a particular intervention has been cost in order to get a single unit of a health outcome such as get to live a more year or prevent death. Based on this particular article it can be seen that the costs of particular intervention diabetes have been included in it along with the effectiveness as well as cost-effectiveness of the intervention (Rutteret al. 2017). The direct medical costs of these type of group of interventions can be compared with the same of the control group.
The direct medical cost for these type of interventions includes both personnel as well as non-personnel costs that are associated with the initial implementation as well as maintenance of this particular intervention. A stated by Lopez Bernalet al. (2018), it can be seen in the article that there was a total of three options analysed by the research to make it cost effective. The first option stated that all of the interventions were delivered with an anticipation of 10% effectiveness and without a proper physician. In this article, the second option was chosen as there were certain possible limitations in the strength of the staffs and the time of their availability. The third option was not chosen because it included group sessions that has a possibility to be effective by 10%.
It is quite difficult to evaluate the effectiveness as well as cost-effectiveness of a complex public health intervention, such as diabetes in the community. As stated by Moberget al. (2018), there are so many interventions hence; the doctors are not able to have any idea that how much a person gets affected due to a particular health intervention.
As diabetes has become one of the most common yet complex health interventions hence; it has become very important to prevent this particular disease as soon as possible. With diabetes, there are a lot more interventions that can attack a human body hence; they can attack different organs of the body at the same time (Masterset al. 2017). Therefore, while doing the treatment of diabetes it is quite hard for doctors to evaluate the effectiveness of the particular intervention. In order to prevent delay NNT (number needed to treat) is used by the doctors. NNT is generally calculated as 1 divided by the absolute reduction of risk. As the immunity power of each human body is not similar hence; whale seeing a diabetic patient it cannot be said that how much they are affected by this particular intervention.
As stated by Viner, White & Christie (2017), researchers, policymakers and practitioners are showing interest to evaluate complicated interventions that are stemming from necessity to enhance effectiveness of interventions. On other hand, Ramachandran et al. (2007) argued and opined that standardisation of treatment interventions is very challenging as multiple interacting components need to be proper synchronisation. In context of standardisation, major problems include- variation likelihood in service delivery on side of supply. In contrast, in context of demand, it is challenging to incorporate all perspectives of disease stages, preferences, needs, and diagnosis of patients. In addition to that, heterogeneity in settings, training, experiences, and lacking standardisation are important problems while arranging health arrangements. Additionally, Tanner-Smith & Grant (2018) propounded that maintaining flexibility degrees is difficult for implementing and designing health interventions.
In order to implement such interventions, lack of planning in health settings can cause failure of meeting objectives. Resource and time difficulties create major threats in delivering interventions; while there can be additional financial and political considerations. In this context of interventions for diabetic patients, intervention’s incremental effectiveness had been measured as “Number Needed to Treat” or NNT regarding that intervention. As stated by Ramachandran et al. (2007), sustainability, regulation and replication in health practices make demands regarding staffs that are important resource in successful interventions. However, in concerned health intervention for diabetic patients, a wide range of team members were involved such as helpers, social workers, dieticians, laboratory technicians and physicians. In contrast, Michie et al. (2018) stated that lack of engagement of patients is a major issue to manage health conditions actively. As a consequence, biased comparisons can take place between control groups and interventions. In the case study of diabetes intervention, “Indian Diabetes Prevention Program” or IDPP has been considered and awareness enhancement of diabetic patients has been prioritised. Despite above-mentioned challenges, intervention-related cost-effectiveness had been assessed by utilising actual costs. Furthermore, sensitivity analysis had also been performed by applying possible variations in this selected health intervention.
Cost effectiveness
The increased cost of intervention process for the public health is calculated according to the standard cost involved in the lifestyle of the people. The effectiveness increment of the intervention is equal with the intervention procedure and the delay in the cost effectiveness ratio can be prevented in one case of diabetes. The cost can be calculated for the increments cost which is effective in the procedure with multiple the cost of effectiveness with incremental cost. The sensitivity can be analyzed based on the possible variations developed in the protocol which influence the outcomes (Ansah et al. 2021). Three options can be analyzed for the cost effectiveness including the intervention which can be delivered without the physician reducing the effectiveness in 10%. The procedure can be done as the physician is not available in many places in the country and the fees and cost for appointment is high enough. As the cost is high in preventing the disease and the cost effectiveness process can save the issues in the areas.
The field staff for the areas of community in the country can demand the instructions and advice from the medical consultants in the emergency situation for any public health intervention among people. Therefore, cost effectiveness can help to solve the issues of unavailability of the medical staff in the areas where public intervention is high. The limitation of the strengths and knowledge of the staff with limited time can affect the process of disease control. The advice can be given in the group session arranged in the community in the country and motivation can be given to the staff of medicine (Dennis et al. 2018). Therefore, the procedure can be cost effective in the market as the cost is not high in the group session for health advice. Alternative process for the group session in the prevention of health intervention can be developed by the group discussion. Cost effective process in group discussion can handle 10% giving motivation to the medical staff. Public health intervention can be managed effectively with low cost in the communities of India for diseases and the effectiveness can be improved also.
Conclusion
From above discussion, it can be summarised that creating awareness is considered to be a serious challenge for making complex health interventions successful. Inequalities in delivery and differences in intervention frequency can create risks to meet objectives of these interventions. However, selected research considered worsening condition of health inequalities in overall population. This article has emphasised the arguments of economists, focusing on benefits and costs to individuals.
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