Evaluasi Ekonomi Program Kesehatan 311011

8/11/2019 Evaluasi Ekonomi Program Kesehatan 311011

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Evaluasi Ekonomi Program Kesehatan

KMPK 31.10.11

Ari Probandari

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pa a eva uas e onom

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The com arative anal sis of alternatives courses

of action in terms of both cost and

consequences

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Programme ACost A

Consequences A

Choice

Comparator BCost B

Consequences B

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Partial vs Full Economic Evaluation

no yes

Are both costs (inputs) and consequences (outputs) of the alternatives examined?

noExamines only

consequences

Examines

only cost

PARTIAL EVALUATION PARTIAL EVALUATION

Is there

comparison

Outcome

description

Cost

description Cost-outcome description

more

alternatives

?

yes Efficacy orCost minimization analysis

Cost effectiveness analysis

PARTIAL EVALUATION FULL ECONOMIC EVALUATION

effectiveness

evaluation Cost Analysis

Cost utility analysis

Cost benefit analysis6


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engapa eva uas e onom

diperlukan?

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memproduksi semua output yang kita inginkandan butuhkan.

Perlu membuat keputusan rasional

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Assess wether

interventions achieve

Assess whether the

interventions meet

maximum output in a

certain level of input or

objectives, which improve

the welfare of one person

output with less input.

welfare of another.

Source: Glossary of Frequently Encountered Terms in Health Economics.http://www.nlm.nih.gov/nichsr/edu/healthecon/glossary.html


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Type of study Cost Identification of

consequences

Consequences

Cost

minimization

analysis

Dollars Identical None

Cost

effectivenessanalysis

Dollars Single outcome, common

to both alternatives, butachieved in different

Natural units (e.g. life

years gained, disability-days saved, points of

,

etc)

Cost utilityanal sis Dollars Single or multipleoutcome not necessar DALY or QALY

common to both

alternative

Cost Benefit Dollars Single or multiple Dollars

Analysis outcome, not necessarycommon to both

alternative

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Bia a an dihitun adalah o ortunit cost

(biaya kesempatan) Biaya kesempatan adalah the value of

opportun ty orgone, str ct y t e estopportunity forgone, as a result of engaging

.(http://www.nlm.nih.gov/nichsr/edu/healthecon/glossary.html#Cost, 2011)

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Incremental costs

Fixed costs

Total costs

Indirect costs

vo e cos s13


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perhitungan biaya: perspektif penyedialayanan kesehatan ataukah perspektif

masyarakat?

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Sensitization and mapping of DOT

Training

Routine interaction with/supervisionof providers

Dru s

Other visits for patient monitoring Defaulter tracing

Health education for patients

Sputum smears for screening anddiagnosis

Sputum smears for monitoring

X-rays

Programme Management

Wasor

Beyond project expenditure

Other diagnostic tests

Routine interaction with PRM healthcentre

Visits by detailers/TB programmers

NTP and KNCV Staff involvement

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Biaya pasien Biaya pendamping ranspor a ons

Consultations (outpatient)

Hospitalization

Investigations (laboratory, X-ray,

ranspor a on

Time taken to accompany patient

Wages lost

Days lost from studies (e.g.. .

Drugs

Time taken to access treatment

Wages lost by patient

Other

Days lost from studies (e.g.school/college) by patient

Interest paid on loans

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Tergantung dari jenis evaluasi ekonomi yang

akan dilakukan

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An economic evaluation in which the cost

and consequences of alternativeinterventions are expressed cost per unit

(http://www.nlm.nih.gov/nichsr/edu/healthe

con/glossary.html, 2011) Evaluasi ekonomi antar beberapa

alternatif dengan tingkat konsekuensian berbeda teta i da at dibandin kan

dengan satu ukuran keluaran. Perbandingan dinyatakan dalam rasio

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- .


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,

Data sekunder (laporan keuangan, databa ian enun an umum dst.

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berhasil disembuhkan melalui implementasiPPM-DOTS di RS dan PS

Penurunan keterlambatan diagnosis dan

pengobatan melalui PPM DOTS

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measure

Logan et al (1981) Treatment of mmHg blood

Schulman et al

(1990)

Treatment of

hypercholesterolemi

% serum cholesterol

reduction

Hull et al (1981) Diagnosis of deep-

vein thrombosis

Cases of DVT

detected

Sculpher and Buxton(1993)

Asthma Episode-free days

Mark et al (1995) Thrombolysis Years of life gained

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Melakukan penelitian (menggali data primermau un sekunder

Memakai data dari literatur yang ada (review

atau metaanalisis

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Cost

600,000

hospital referral

ACER of PPM

DOTS hospital

ICER of PPM DOTS in community

health centre only = 4,000

200,00

0

= 2,000PPM DOTS in community health

centre only

0

Effectiveness200 300

ACER of PPM DOTS in community health centre only =1,000

succesfully

treated)


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Handlinguncertaintyinhealth

economic

evaluation

Uncertainty

relatedto

data

inputUncertainty

relatedto

extrapolationUncertainty

relatedto

analysis

method

PresentingCIofCER forsampled

data

Whendataisextrapolatedor

modelled

Ex.presentingresultswith

different

discount

Calculation

of

power

to

adjust

adequacy

of

sensitivityana ysis rate.

z

Source: Drummond MF, & Jefersson TO. Guidelines for authors and peer reviewers of economicsubmissions to the BMJ. BMJ 1996; 313: 275.


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between

inputs

and

consequences,

varying

.

sodoing,sensitivityanalysisteststhe

itemsaroundwhichthereisuncertainty.

. . .

on/glossary.html,

2011

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em an ng an a au e p an engan ng a

effectiveness yang sama, untuk mencari mana yangmembutuhkan paling sedikit resources.

Bentuk khusus dari CEA (CEA dengan ukuran efektivitas

yang besarnya sama)

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orm o econom c s u y es gn n w c

interventions which produce different consequences,in terms of both uantit and ualit of life.

Pada CUA, quality of life dan morbiditas

diperhitungkan sebagai outcome dari program. ost per qua ty a uste e years atau cost

per DALY (disability adjusted life years)

life years gained as a result of healthinterventions/health care programs with a judgment

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a ou e qua y o ese e years


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dengan program yang lain mungkin berbeda. Dalam satu ro ram mun kin ada lebih dari 1

outcome.

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A method of comparing the monetary value ofall benefits of a ro ect with all costs of that

project

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uang.-

sebagai Net Social Benefit (NSB)

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prevention/treatment/control, which would be incurred by thehealth service or patient or society at large

Indirect benefit: roduction losses which would have occurredas a result of death, or incapacity or reduced productivity,including through interrupted education, which have now been

avoided n ang e ene , .e. pa n, anx e y or o er re uc on n qua y

of life, either in patients or their relatives and friends, which hasnow been avoided

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Metode untuk mengukur benefit dalam nilai uang

Whose

judgement?

How it is elicited Example

Policy-makers/public Explicit/stated preference e.g. court orders: how much is paid in

Implicit in

decisions/revealed

e.g. legislation on road safety: how much is

spent on it

Individuals

(patients or

Direct

survey/stated

Willingness to pay (WTP)

surveys, e.g. contingent

you pay to avoid X condition?

e.g. conjoint analysis: ranking

attributes to ascertain

preference and WTP

behaviour/revealed

preference

. . ,

payments

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- -

health benefits by directly eliciting individualpreferences in the views of samples of the

general public who are asked how much they

would be prepared to pay to accrue a benefitor o avo cer a n even s.

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Evaluasi Ekonomi Program Kesehatan 311011

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