Neurological, Psychiatric, and Developmental Disorders Meeting the Challenge in the Developing World (2001) / Chapter Skim
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Appendix D Economic Analysis
Appendix D Economic Analysis
Pages 397-418
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From page 397... ...
Murthy Reprinted with permission Tom the Royal College of Psychiatrists ~ 2000 The guidelines have been drawn up in order to provide an overview of issues, principles and procedures related to the economic analysis of mental health care programs in low-income countries; are aimed at mental health workers who have an interest in incorporating an economic perspective into their evaluative research activities; are largely based on the principles and methods used in the United States and United Kingdom, but also reflect an additional set of features associated with the implementation of these methods in the context of low-income countries; and do not attempt to be comprehensive, and it is recommended that a local health economist or closest equivalent is consulted in their application. THE RATIONALE FOR AN ECONOMIC PERSPECTIVE The increasing recognition of mental health as a significant public health issue globally has led to additional demands for resources that are already stretched.
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From page 398... ...
PLANNING AND DESIGNING AN ECONOMIC STUDY For an appropriate economic evaluation of a mental health care intervention, program or strategy, a number of study design features need to be considered. Since economic evaluations often take place alongside clinical evaluations or trials, the design of the study will typically need to be agreed to in conjunction with other evaluators.
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From page 399... ...
The final option is costbenefit analysis, which refers to a form of evaluation in which all costs and outcomes are valued in monetary units, thereby allowing assessment of whether a particular course of action is worthwhile, based on a simple decision rule that benefits must exceed costs. This approach is difficult to undertake because of the requirement to quantify outcomes in monetary terms, and consequently is found very rarely in mental health care evaluation.
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From page 400... ...
Opportunity cost estimates can be applied subsequently to these data in order to calculate the overall economic costs associated with an individual's care, or at a more aggregated level, a particular intervention or strategy. An initial stage in the recording of resource utilization data is the identification of relevant components of potential service receipt by users, such as contacts with primary care physicians and other health workers, communitybased private or voluntary sector providers and hospital inpatient and outpatient care (both psychiatric and general)
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From page 401... ...
The other determining feature of the annuity factor is the prevailing discount rate for public and/or private capital assets (this should be available through local government offices)
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From page 402... ...
Thus, while process indicators are undoubtedly an important source of differentiation between study samples at the institutional level, their use as indicators of improved patient welfare needs to be treated with caution. Final outcomes, on the other hand, are concerned with detecting changes in the physical, psychological or social wellbeing of individuals, and commonly revolve around the measurement of symptoms, functioning and disability, quality of life and service satisfaction.
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From page 403... ...
For example, an intervention that costs an extra Rupees 1,000 over a year and produces an additional improvement of 5 points on a social functioning measure compared to usual care, would result in a positive ratio of Rupees 200, interpreted as the increased average cost necessary to gain an average of 1 point of improvement per year. The cost-effectiveness ratio is negative when the innovative intervention costs less but has superior outcomes (i.e., cost saving)
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From page 404... ...
. In this context, it is worth noting that economic evaluation is no panacea for making difficult allocative and policy decisions; rather, it is one additional tool that together with clinical and social dimensions can facilitate explicit, evidencebased decision-making.
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From page 405... ...
Commission on economic aspects, in a recent report, has highlighted the need for thorough appraisal of the economic aspects of epilepsy tad. Thorough economic appraisal of newer strategies in epilepsy care, be it newer AEDs or epilepsy surge~y, would enable the clinician to make judicious decisions in patient care.
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From page 406... ...
These factors also should be considered while computing the cost of epilepsy care. The direct cost of epilepsy is gathered in one of the three methods viz.
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From page 407... ...
Indirect cost 407 Benefits Morbidity Control of seizures . improvement In cognition Morbidity due to adverse drug reaction Morbidity due to surgery if any Mortality Lives saved Lives lost due to adverse drug effects or surgery Psychosocial Improvement in quality of life Quality adjusted life years r.
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From page 408... ...
14) Country, year Population Cost Direct cost indirect cost measures Australia, All epilepsies 1993 Switzerland, individuals 1993 on AED UK, 1990 USA, 1994 India, 1998 All active and inactive ep~leps~es Refractory adult epilepsy Active and .
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From page 409... ...
Third party payer's perspective examines cost evaluation from the insurance company or employer's viewpoint. Societal perspective examines the entire social and economic effect of the new treatment (e.g., epilepsy surgery)
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From page 410... ...
These studies indicate that epilepsy is an enormous economic burden to the society and the major component of the cost is the indirect cost constituted by lost productivity. With effective treatment, 70-80% Of patients can go in for remission and can be effectively rehabilitated with positive economic gain.
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From page 411... ...
For example, the anxiety that one may lose memory following the surgery is a cost and the peace of mind that seizures will not occur is a benefit which are difficult to translate into monetary units. By using monetary values on both sides of the economic appraisal equation, it is possible to estimate the net gain to the society from a particular treatment.
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From page 412... ...
However the overall cost of treating epilepsy with such drugs could be less because of savings from fewer hospital visits for seizures, or management of adverse drug reactions or increased productivity. Similarly, the one-time cost of presurgical evaluation and epilepsy surgery is many times more than that of medical treatment, but the lifetime cost would be less for patients who achieve complete remission by surgery.
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From page 413... ...
Two recent studies t25,26] have shown that the outcome cost (acquisition cost plus the cost of treating adverse drug reactions)
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From page 414... ...
A study from another tertiary referral center for epilepsy in North India has suggested that the cost of epilepsy care can be reduced and the quality of care improved by proper clinical evaluation and education of general physicians.~31] Another recent study had shown that the frequency of polytherapy with its associated higher cost can be reduced by intervention from a tertiary referral center [32~.
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From page 415... ...
Similarly, the savings in teens of fewer hospital visits or admission, fewer adverse drug reactions that need intervention and better quality of life may overcome the higher acquisition cost of some of the newer drugs or surgical treatment. However, the cost of epilepsy care from the societal perspective would increase many-fold if the same treatment and investigations are administered to all patients.
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From page 416... ...
5. Beran RG, Banks GK: indirect costs of epilepsy in Australia.
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From page 417... ...
24. Malmgren K, Hedstrom A, Granquist R et al: Cost analysis of epilepsy surgery and of vigabatrin treatment in patients with refractory partial epilepsy.
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