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Martin Muchangi
Regional Programme Manager  |  Kenya
Hi, I am developing my thesis proposal and would like to measure the health and economic benefits of a the government programme known as managed equipment services vide: http://www.uncitral.org/pdf/english/congress/Papers_for_Congress/61-OLOTCH-Managed_Equipment_Services_for_Sustainable_Development.pdf. I prefer cost utility analysis because I would like to demonstrate the real value of the intervention in improving health. I am limited by the fact that there was no such intervention previously so its difficult to calculate ICUR. Additionally, there is no comparison between the current intervention and any other since this is new. What method should I adopt?

Expert Replies:

Wanrudee Isaranuwatchai

Assistant Professor  |  Canada  |   Replied: 04 Jan 2019 at 16:47
Hi, thank you for your question. Your thesis topic sounds very interesting and it is exciting that you would like to examine the value of the intervention in term of both of cost and outcome (i.e., conducting an economic evaluation).

Cost-utility analysis is one type of economic evaluations where the effectiveness outcome is measured in term of quality-adjusted life year (QALY). All types of economic evaluation consider cost but each type deals with outcome in different form. Therefore, even if you do not have data to estimate QALY, you could still conduct an economic evaluation. A question for you is “how would you measure (using what outcome) the impact (or success) of your intervention (in this case MES)?”.

Regarding a comparison, you could compare your new intervention to the current intervention (even though there has not been another comparison before).

The following references may be helpful for your questions and next steps in conducting an economic evaluation.
• The International Decision Support Initiative. 2018. Health Technology Assessment Toolkit. Available at https://f1000research.com/documents/7-1545
• The International Decision Support Initiative. 2016. iDSI Reference Case for Economic Evaluation. Available at https://www.idsihealth.org/resource-items/idsi-reference-case-for-economic-evaluation/
• Hoch, J. S., & Dewa, C. S. (2005). An introduction to economic evaluation: What's in a name? Canadian Journal of Psychiatry, 50(3), 159-166 (http://healtheconomics.utoronto.ca/wp-content/uploads/cjp-mar1-05-hoch-OR2.pdf)
• Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes. Oxford university press

Hope this helps.
Happy proposal writing.

Mark Jit

Professor  |  United Kingdom  |   Replied: 04 Jan 2019 at 16:34
In general, these kinds of complex policy interventions are difficult to evaluate using decision analytic modelling alone. Your best bet is to try to look for some kind of observational data that could inform an economic analysis - eg. if some health facilities or provinces benefitted from the project later than others you could try to do some kind of controlled before-after study. I would not recommend an uncontrolled before-after analysis since there will be so many unknown time-dependent confounders.

Failing that, you could try to estimate the health benefits of the project by working with one or two hospitals to look very closely at what the investment bought and how it might have improved health, but I think this will be an extremely complex, data-intensive and possibly not terribly reliable exercise.

Wanrudee Isaranuwatchai

Assistant Professor  |  Canada  |   Replied: 04 Jan 2019 at 16:53
I would like to second Mark's points; all of which are very relevant and important.

Some references which may be helpful on complex interventions:
+ Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. Bmj, 337, a1655.
+ Moore, G., Audrey, S., Barker, M., Bond, L., Bonell, C., Cooper, C., ... & Wight, D. (2014). Process evaluation in complex public health intervention studies: the need for guidance.
+ Campbell, M., Fitzpatrick, R., Haines, A., Kinmonth, A. L., Sandercock, P., Spiegelhalter, D., & Tyrer, P. (2000). Framework for design and evaluation of complex interventions to improve health. Bmj, 321(7262), 694-696.

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Expert Profiles

Wanrudee Isaranuwatchai

Assistant Professor
Assistant Professor, University of Toronto

Mark Jit

Professor
London School of Hygiene & Tropical Medicine, UK