Extended Cost Effectiveness Analysis (ECEA) Carol Levin Presented - PowerPoint PPT Presentation

www.dcp-3.org info@dcp-3.org Extended Cost Effectiveness Analysis (ECEA) Carol Levin Presented at the ‘Workshop of the Costing and Financing Studies of Routine Immunization’ Geneva, 4-6 November 2013 1/9/2014 1

Overview • Background a new perspective on economic evaluation • Equity definitions & examples • Financial risk protection definitions & examples • Case study public finance of TB treatment in India

Background A new perspective on economic evaluation

Background (1) • Traditional economic evaluation focus Cost-effectiveness of technical interventions targeting specific diseases (e.g. antiretroviral therapy for HIV/AIDS) • Decision-making & priority setting focus Resources allocated across different options 1) Health interventions 2) Health service delivery platforms 3) Health policy levers (e.g. public finance, conditional cash transfers, taxation) Take consideration of several criteria: -- burden, costs, equity, medical impoverishment

Economic evaluation of health policy instruments From: Cost Effectiveness Analysis (CEA) To: Extended Cost Effectiveness Analysis (ECEA) (1) Distributional consequences across wealth strata of populations (2) Insurance and financial protection benefits for households (3) Financial consequences for households

Equity

Principles of equity (2) Measles vaccine coverage • Fairness in the distribution 100 of health coverage 80 (ex: measles vaccine coverage) Coverage (%) 60 Measles deaths per 1,000,000 births 40 2000 20 Measles deaths 1500 0 Coverage (%) Income Quintile (Poorest to Richest) 1000 • Fairness in the distribution 500 of health outcomes (ex: measles deaths) 0 Income Quintile (Poorest to Richest)

Financial risk protection

Medical impoverishment • When confronted with expensive medical expenditures, poor people can face high out-of- pocket (OOP) payments and fall into poverty – Threshold-base approach – Forced Asset Sales – Money-metric value of insurance

Wagstaff, 2010

ECEAs of vaccines e.g. how do vaccines position themselves? Health gains & financial protection afforded, per $1M spent RV PCV 25000 MCV R,TSS HPV FRP ($) 15000 5000 FRP = financial risk protection (prevention of medical impoverishment) 0 0 200 400 600 800 1000 11 Deaths averted

Priority setting & UHC • Design basic insurance packages Low Health gains High Health gains High FRP High FRP FRP High Health gains Low Health gains Low FRP Low FRP FRP = financial risk protection (prevention of medical impoverishment) Deaths averted 12

Example Impact of HPV vaccination policy in on distributional and financial risk protection

Summary measures of ECEA Health policy lever for an intervention (e.g. HPV vaccination program) Financial risk protection Household Health gains benefits expenditures (e.g. Cancer deaths (e.g. relative (e.g. Cancer treatment averted) importance of expenditures averted) treatment expenditures) 2 nd Richest 2 nd Poorest Richest Poorest Middle

Benefits and costs of a publically financed HPV vaccination policy in China (US $ 2009)

Health Gains Deaths Averted 3500 3000 2500 Deaths Averted 2000 1500 1000 500 0 1 2 3 4 5 Quintile

Savings and Financial Risk Protection Savings vs. Financial Risk Protection 70% $9,000,000 $8,000,000 60% $7,000,000 50% Savings as a % of income $6,000,000 Absolut Savings 40% $5,000,000 $4,000,000 30% $3,000,000 20% $2,000,000 10% $1,000,000 0% $- 1 2 3 4 5 Quintile Savings as a percentage of income Patient Cost Savings

Thank you DCP3 Team HPV vaccination ECEA • Stéphane Verguet • Monisha Sharma Dean Jamison • Zach Olson Rachel Nugent • Stéphane Verguet Zach Olson • Dean Jamison Elizabeth Brouwer • Jane Kim