Beyond Impacts: Cost Effectiveness Analysis of Health Interventions

Transcription

1 Benjamin Schwab International Food Policy Research Institute (IFPRI) Beyond Impacts: Cost Effectiveness Analysis of Health Interventions Contributions from Edit Velenyi Impact Opportunities: Evidence and Action to Save Lives in Nigeria Uyo, Nigeria, May 7-10, 2013

2 An Example from Ecuador The Scenario: The World Food Program wants to know how well three different types of food assistance raise food security outcomes: Food baskets Cash transfers Vouchers IFPRI conducts a randomized comparison in Northern Ecuador What were the findings? 2

3 Example from Ecuador EFFECT OF EACH MODALITY ON FOOD CONSUMPTION SCORE (FCS) MODALITY SPECIFIC COST TO TRANSFER $40 VALUE $11.5o % 6.0 $ $ Source: Hidrobo et al (2012) Food FCS Cash 0 Source: Hidrobo et al Cost Food Cash 3

4 Example from Ecuador (cont) So how do cash and food compare on the cost effectiveness of improving FCS? How much would it cost to improve FCS by 15%? $ $ $ Source: Hidrobo et al (2012) Cost of Improving Food Security Outcomes by 15% Food Cash 4

5 Purpose of Presentation Motivate reasons for costing work Describe basics of the costing process Introduce some common issues in costing 5

6 Motivation So why worry about costing? Improves lessons from impact results Eases comparison between studies of different interventions in different contexts More relevant information for policy makers choosing interventions 6

7 Types of Costing Analysis Cost benefit analysis Ratio of $ of benefits per $ of costs Cost utility analysis Ratio of a metric of utility/wellbeing per $ of costs Cost Effectiveness Analysis Ratio of a defined outcome per $ of costs The differences depend on how the numerator (i.e. the benefit) is quantified, not the denominator (i.e. costs) CEA often most relevant to IE 7

8 Costing Methodology The Ingredients Approach What are the inputs needed to produce the program outputs? Goes beyond program budget ABC Activity Based Costing Very common approach Organizes inputs by activities 8

9 Basics of Costing Analysis in IE Understand the subject & goal of the impact evaluation Define the appropriate cost framework (e.g. ABC) Identify the necessary ingredients (i.e. activities/inputs) Devise a data collection plan for costs Coordination between multiple parties Value the different ingredients Marginal vs. fixed costs Analyze the cost data Inflation/currency adjustments, etc 9

10 Example: Cash vs. Food Modality-specific costs: Cost centers for food Purchasing the food Storage, transportation, & delivery Supervision of food distribution (i.e. hired labor) Coordination/oversight (i.e. staff time) Cost to beneficiaries to travel to food distribution point Cost centers for cash Cash delivery (i.e. bank transaction fee) Contracting costs Coordination/oversight (i.e. staff time) Cost to beneficiaries to travel to bank 10

11 Example: Community Child Health Program (Honduras) The Community-Based, Integrated Child Care Program (Atención Integral a la Niñez- Comunitaria, AINC) Community volunteer groups supporting new mothers with information on vaccinations, feeding practices, nutrition, and referrals to health services 11

12 Example: Total Cost Breakdown Reproduced from Fiedler (2003) 12

13 Example: Recurrent Cost Breakdown Reproduced from Fiedler (2003) 13

14 Common Issues Marginality System vs. incremental costs What to do with startup & lumpy costs? Sensitization campaigns, facilities, etc Valuation of subsidized costs How to value a volunteer s time? Donated medication? Beneficiary costs Answers will be guided by ultimate IE goal 14

15 Some Guidelines Consistency in measurement Must be valid comparison of treatment arms Contextualize the costs The final number is not as helpful if sources of cost differences not identified Sensitivity to valuation assumptions to contextual factors (e.g. population density) 15

16 Example: Uganda HPV Vaccine Costing ingredients Reproduced from la Briere (2013). Original source C. Levin, PATH 16

17 Uganda HPV Vaccine Costing results of pilot with extrapolation to scaled-up national program * Per girl means with full vaccine (3 doses) in the pilot and per eligible girl in the program. Launching costs after two years of pilot and one year of bridging. Reproduced from la Briere (2013). Original source C. Levin, PATH 17

18 Comparison Using CEA Reproduced from Dhaliwal et al (2012). 18

19 Key takeaways Costing can add a valuable dimension to impact evaluation work Very useful for comparing competing interventions within AND across contexts Costing can be costly (but valuable)! Many different sources of costing data that need to be collected Cost caluclations should not be a black box Make assumptions explicit and show alternatives 19