scholarly journals Equity and economic evaluation of system-level health interventions: A case study of Brazil's Family Health Program

2020 ◽  
Author(s):  
James Love-Koh ◽  
Andrew Mirelman ◽  
Marc Suhrcke
Keyword(s):  
Economic Evaluation ◽  
Social Welfare ◽  
Population Health ◽  
Health Interventions ◽  
System Level ◽  
Disability Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Average Health

Abstract Distributional economic evaluation estimates the value for money of health interventions in terms of population health and health equity impacts. When applied to interventions delivered at the population and health system-level interventions (PSIs) instead of clinical interventions, additional practical and methodological challenges arise. Using the example of the Programme Saúde da Familia (PSF) in Brazil, a community-level primary care system intervention, we seek to illustrate these challenges and provide potential solutions. We use a distributional cost-effectiveness analysis (DCEA) approach to evaluate the impact of the PSF on population health and between-state health inequalities in Brazil. Data on baseline health status, disease prevalence and PSF effectiveness are extracted from the literature and incorporated into a Markov model to estimate the long-term impacts in terms of disability-adjusted life years. The inequality and average health impacts are analysed simultaneously using health-related social welfare functions. Uncertainty is computed using Monte Carlo simulation. The DCEA encountered several challenges in the context of PSIs. Non-randomized, quasi-experimental methods may not be powered to identify treatment effect heterogeneity estimates to inform a decision model. PSIs are more likely to be funded from multiple public sector budgets, complicating the calculation of health opportunity costs. We estimate a cost-per-disability-adjusted life years of funding the PSF of $2640. Net benefits were positive across the likely range of intervention cost. Social welfare analysis indicates that, compared to gains in average health, changes in health inequalities accounted for a small proportion of the total welfare improvement, even at high levels of social inequality aversion. Evidence on the population health and health equity impacts of PSIs can be incorporated into economic evaluation methods, although with additional complexity and assumptions. The case study results indicate that the PSF is likely to be cost-effective but that the inequality impacts are small and highly uncertain.

Identifying Public Health Problems

2018 ◽  
Author(s):  
Scott Burris ◽  
Micah L. Berman ◽  
Matthew Penn, and ◽  
Tara Ramanathan Holiday
Keyword(s):  
Public Health ◽  
Health Problems ◽  
Health Priorities ◽  
Disability Adjusted Life Years ◽  
Quality Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Study Designs ◽  
Quality Adjusted Life

Chapter 5 discusses the use of epidemiology to identify the source of public health problems and inform policymaking. It uses a case study to illustrate how researchers, policymakers, and practitioners detect diseases, identify their sources, determine the extent of an outbreak, and prevent new infections. The chapter also defines key measures in epidemiology that can indicate public health priorities, including morbidity and mortality, years of potential life lost, and measures of lifetime impacts, including disability-adjusted life years and quality-adjusted life years. Finally, the chapter reviews epidemiological study designs, differentiating between experimental and observational studies, to show how to interpret data and identify limitations.

scholarly journals Economic valuation of increased malaria due to climate change: A South African case study

2002 ◽  
Vol 5 (2) ◽  
pp. 395-412 ◽  
Author(s):  
Randall Spalding-Fecher ◽  
Shomenthree Moodley
Keyword(s):  
Climate Change ◽  
South African ◽  
Economic Valuation ◽  
Disability Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Projected Changes ◽  
Complex Health Problems ◽  
Valuation Tools

Malaria is one of the world's most serious and complex health problems. It is also one of the diseases identified as most likely to be affected by climate change, because transmission is sensitive to temperature and rainfall. The objective of this paper is to provide an initial economic valuation of the increased incidence of malaria due to projected changes in climate in South Africa, excluding costs and benefits of prevention and adaptation. We use market based economic valuation tools for morbidity, including cost of treatment and lost short term productivity, and report lost disability adjusted life years from malaria mortality due to climate change. We also discuss how human capital and willingness to pay approaches could be used for mortality valuation. The results show that the opportunity cost of increased morbidity from malaria would be between R277 million and R466 million in 2010, while the lost disability adjusted life years from increased mortality would be from 11 800 to 18 300 years in that year.

A risk assessment case study in the suburbs of Paris: balancing health effects of Cryptosporidium parvum and bromate

2002 ◽  
Vol 2 (3) ◽  
pp. 205-211
Author(s):  
V. Dilé-Mary ◽  
C. Galey ◽  
D. Gatel ◽  
J. Cavard ◽  
A. Havelaar
Keyword(s):  
Risk Assessment ◽  
Cryptosporidium Parvum ◽  
Disease Burden ◽  
Cell Cancer ◽  
Sharp Decrease ◽  
Risk Of Infection ◽  
Disability Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years

To meet newly proposed bromate standards, ozone doses should be decreased, thus also decreasing the risk of renal cell cancer, but the risk of infection with Cryptosporidium parvum will increase at the same time. The present study was designed to evaluate and balance these two risks, using a probabilistic risk assessment, which involves calculating the disease burden, expressed in the number of disability adjusted life-years (DALY) as developed by Havelaar et al. In the case of Neuilly-sur-Marne ozone contactors, four ozone doses were studied at 5°C and at 22°C. Results showed a sharp decrease of the disease burden with the application of ozone, and then a slight increase as the ozone dose was increased. Minimal DALYs were obtained with ozone doses of 1.5 mg/L at 22°C and 2.5 mg/L at 5°C. Nevertheless, these two ozone doses do not comply with the 10 μg/L bromate standard, as an average of 12 at 5°C and 11 at 22°C are produced.

scholarly journals Population health, economics and ethics in the age of COVID-19

2020 ◽  
Vol 5 (7) ◽  
pp. e003259 ◽  
Author(s):  
Sanjay G Reddy
Keyword(s):  
Public Health ◽  
Population Health ◽  
Disability Adjusted Life Years ◽  
Quality Adjusted Life Years ◽  
Health Measures ◽  
Balanced Approach ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Aggregate Population ◽  
Quality Adjusted Life

Are the steps that have been taken to arrest the spread of COVID-19 justifiable? Specifically, are they likely to have improved public health understood according to widely used aggregate population health measures, such as Quality Adjusted Life Years (QALYs) and Disability Adjusted Life Years (DALYs) as much or more than alternatives? This is a reasonable question, since such measures have been promoted extensively in global and national health policy by influential actors, and they have become almost synonymous with quantification of public health. If the steps taken against COVID-19 did not meet this test, then either the measures or the policies must be re-evaluated. There are indications that policies against COVID-19 may have been unbalanced and therefore not optimal. A balanced approach to protecting population health should be proportionate in its effects across distinct health concerns at a moment, across populations over time and across populations over space. These criteria provide a guide to designing and implementing policies that diminish harm from COVID-19 while also providing due attention to other threats to aggregate population health. They should shape future policies in response to this pandemic and others.

scholarly journals Inequalities in population health loss by multiple deprivation: COVID-19 and pre-pandemic all-cause disability-adjusted life years (DALYs) in Scotland

2021 ◽  
Author(s):  
Grant Mark Andrew Wyper ◽  
Eilidh Fletcher ◽  
Ian Grant ◽  
Oliver Harding ◽  
Maria Teresa de Haro Moro ◽  
...  
Keyword(s):  
Population Health ◽  
Health Inequalities ◽  
Burden Of Disease ◽  
Health Impact ◽  
Disability Adjusted Life Years ◽  
Multiple Deprivation ◽  
Health Loss ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Index Of Inequality

Background: COVID-19 has caused almost unprecedented change across health, education, the economy and social interaction. It is widely understood that the existing mechanisms which shape health inequalities have resulted in COVID-19 outcomes following this same, familiar, pattern. Our aim was to estimate inequalities in the population health impact of COVID-19 in Scotland, measured by disability-adjusted life years (DALYs) in 2020. These were scaled against pre-pandemic inequalities in DALYs combined across all causes, derived from the Scottish Burden of Disease (SBoD) study.Methods: National deaths and daily case data were input into the European Burden of Disease Network consensus model to estimate DALYs. Total Years of Life Lost (YLL) were estimated for each area-based deprivation quintile of the Scottish population. Years Lived with Disability were proportionately distributed to deprivation quintiles, based on YLL estimates. Inequalities were measured by: the range, Relative Index of Inequality (RII), Slope Index of Inequality (SII), and attributable DALYs were estimated by using the least deprived quintile as a reference. Overall, and inequalities in, COVID-19 DALYs were scaled against pre-pandemic estimates of inequalities across all causes from the SBoD study.Results: Marked inequalities were observed across several measures. The SII was 2,048–2,289 COVID-19 DALYs per 100,000 population. The RII was 1.16, meaning that the rate in the most deprived areas was around 58% higher than the mean population rate, with 40% of COVID-19 DALYs attributed to differences in area-based deprivation. Overall DALYs due to COVID-19 ranged from 7–20% of the annual pre-pandemic impact of inequalities in health loss combined across all causes.Conclusion: The substantial population health impact of COVID-19 in Scotland was not shared equally across areas experiencing different levels of deprivation. The extent of inequality due to COVID-19 was similar to averting all annual DALYs due to diabetes. In the wider context of population health loss, overall ill-health and mortality due to COVID-19 was, at most, a fifth of the annual population health loss due to inequalities in multiple deprivation. Implementing effective policy interventions to reduce health inequalities must be at the forefront of plans to recover and improve population health.

scholarly journals Inequalities in population health loss by multiple deprivation: COVID-19 and pre-pandemic all-cause disability-adjusted life years (DALYs) in Scotland

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Grant M. A. Wyper ◽  
Eilidh Fletcher ◽  
Ian Grant ◽  
Oliver Harding ◽  
Maria Teresa de Haro Moro ◽  
...  
Keyword(s):  
Population Health ◽  
Health Inequalities ◽  
Burden Of Disease ◽  
Health Impact ◽  
Disability Adjusted Life Years ◽  
Multiple Deprivation ◽  
Health Loss ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Index Of Inequality

Abstract Background COVID-19 has caused almost unprecedented change across health, education, the economy and social interaction. It is widely understood that the existing mechanisms which shape health inequalities have resulted in COVID-19 outcomes following this same, familiar, pattern. Our aim was to estimate inequalities in the population health impact of COVID-19 in Scotland, measured by disability-adjusted life years (DALYs) in 2020. Our secondary aim was to scale overall, and inequalities in, COVID-19 DALYs against the level of pre-pandemic inequalities in all-cause DALYs, derived from the Scottish Burden of Disease (SBoD) study. Methods National deaths and daily case data were input into the European Burden of Disease Network consensus model to estimate DALYs. Total Years of Life Lost (YLL) were estimated for each area-based deprivation quintile of the Scottish population. Years Lived with Disability were proportionately distributed to deprivation quintiles, based on YLL estimates. Inequalities were measured by: the range, Relative Index of Inequality (RII), Slope Index of Inequality (SII), and attributable DALYs were estimated by using the least deprived quintile as a reference. Results Marked inequalities were observed across several measures. The SII range was 2048 to 2289 COVID-19 DALYs per 100,000 population. The rate in the most deprived areas was around 58% higher than the mean population rate (RII = 1.16), with 40% of COVID-19 DALYs attributed to differences in area-based deprivation. Overall DALYs due to COVID-19 ranged from 7 to 20% of the annual pre-pandemic impact of inequalities in health loss combined across all causes. Conclusion The substantial population health impact of COVID-19 in Scotland was not shared equally across areas experiencing different levels of deprivation. The extent of inequality due to COVID-19 was similar to averting all annual DALYs due to diabetes. In the wider context of population health loss, overall ill-health and mortality due to COVID-19 was, at most, a fifth of the annual population health loss due to inequalities in multiple deprivation. Implementing effective policy interventions to reduce health inequalities must be at the forefront of plans to recover and improve population health.

scholarly journals Measuring the direct population impact of COVID-19 in Scotland, 2020: estimating disability-adjusted life years (DALYs) during the first full calendar year

2021 ◽  
Author(s):  
Grant Mark Andrew Wyper ◽  
Eilidh Fletcher ◽  
Ian Grant ◽  
Gerry McCartney ◽  
Colin Fischbacher ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Population Health ◽  
Health Impact ◽  
Years Of Life Lost ◽  
Disability Adjusted Life Years ◽  
Population Impact ◽  
Disability Adjusted Life ◽  
Life Years ◽  
The Impact

Background: Disability-adjusted life years (DALYs) combine the impact of morbidity and mortality and can enable comprehensive, and comparable, assessments of direct and indirect health harms due to COVID-19. Our aim was to estimate DALYs directly due to COVID-19 in Scotland, during 2020; and contextualise its population impact relative to other causes of disease and injury.Methods: National deaths and daily case data were used. Deaths were based on underlying and contributory causes recorded on death certificates. We calculated DALYs based on the COVID-19 consensus model and methods outlined by the European Burden of Disease Network. DALYs were presented as a range, using a sensitivity based on Years of Life Lost estimates using: cause-specific; and COVID-19 related deaths. All estimates were for 2020.Findings: In 2020, estimates of COVID-19 DALYs in Scotland ranged from 96,500 to 108,200. Direct COVID-19 DALYs were substantial enough to be framed as the second leading cause of disease and injury, with only ischaemic heart disease having a larger impact on population health. Mortality contributed 98% of total DALYs.Interpretation: The direct population health impact of COVID-19 has been very substantial. Despite unprecedented mitigation efforts, COVID-19 developed from a single identified case in early 2020 to a condition with an impact in Scotland second only to ischaemic heart disease. Periodic estimation of DALYs during 2021, and beyond, will provide indications of the impact of DALYs averted due to the national roll-out of the vaccination programme and other continued mitigation efforts, although new variants may pose significant challenges.

scholarly journals SOCIO-ECONOMIC AND ECOLOGICAL IMPACT OF MALARIA – A CASE STUDY OF NEEMUCH, MADHYA PRADESH

2015 ◽  
Vol 3 (9SE) ◽  
pp. 1-4
Author(s):  
Sadhana Sewak
Keyword(s):  
Ecological Impact ◽  
Communicable Diseases ◽  
Morbidity Rate ◽  
Disability Adjusted Life Years ◽  
Mortality And Morbidity ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Vector Borne ◽  
Sub Saharan

Malaria is one of the oldest chronic, most dreaded killer diseases. It is a protozoan Plasmodium borne disease which is transmitted in humans by very efficient mosquito Anopheles. Out of four plasmodium genus, vivax is more dominant and falciparum species likely to cause severe lethal malaria.According to WHO, malaria killed 627000 people in 2012, majority of them sub-Saharan African children under the age of 5. This preeminent tropical parasite disease is one of the top 3 killers among communicable diseases. It is the only vector borne disease to be placed on WHO- DALY’s (disability adjusted life years) list, as it affects the mortality and morbidity rate as well as economy of any country.

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