Journal
TROPICAL MEDICINE & INTERNATIONAL HEALTH
Volume 16, Issue 1, Pages 97-104Publisher
WILEY
DOI: 10.1111/j.1365-3156.2010.02637.x
Keywords
economic evaluation; cost effectiveness analysis; complex interventions; health care evaluation; package of care; clinical practice guidelines; evaluation economique; analyse cout-efficacite; interventions complexes; evaluation des soins de sante; ensemble des soins; directives de la pratique clinique; evaluacion economica; analisis de coste-efectividad; intervenciones complejas; evaluacion de cuidados sanitarios; paquete de cuidados sanitarios; guias de practicas clinicas
Funding
- Wellcome Trust [076827, 097170, 084538] Funding Source: Medline
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Increasingly attention is shifting towards delivering essential packages of care, often based on clinical practice guidelines, as a means to improve maternal, child and newborn survival in low-income settings. Cost effectiveness analysis (CEA), allied to the evaluation of less complex intervention, has become an increasingly important tool for priority setting. Arguably such analyses should be extended to inform decisions around the deployment of more complex interventions. In the discussion, we illustrate some of the challenges facing the extension of CEA to this area. We suggest that there are both practical and methodological challenges to overcome when conducting economic evaluation for packages of care interventions that incorporate clinical guidelines. Some might be overcome by developing specific guidance on approaches, for example clarity in identifying relevant costs. Some require consensus on methods. The greatest challenge, however, lies in how to incorporate, as measures of effectiveness, process measures of service quality. Questions on which measures to use, how multiple measures might be combined, how improvements in one area might be compared with those in another and what value is associated with improvement in health worker practices are yet to be answered.
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