Box 1.3Economic Evaluation of Investments in Cardiovascular, Respiratory, and Related Disorder Control

Economic evaluations aim to inform decision making by quantifying the trade-offs between resource inputs required for alternative investments and the resulting outcomes. Four approaches to economic evaluation in health are the following:

  • Assessing how much of a specific health outcome, such as myocardial infarctions averted, can be attained for a given level of resource input;
  • Assessing how much of an aggregate measure of health, such as deaths or disability adjusted life years [DALYs], can be attained from a given level of resource inputs applied to alternative interventions. This approach—cost-effectiveness analysis (CEA)—enables comparisons of interventions addressing many different health outcomes (for example, heart disease treatment versus tobacco tax);
  • Assessing how much health and financial risk protection can be attained for a given level of public sector finance of a given intervention. This approach, extended CEAs or extended cost-effectiveness analyses (ECEAs), enables assessment not only of efficiency in improving the health of a population but also of efficiency in achieving the other major goal of a health system—protecting the population from financial risk;
  • Assessing the economic benefits, measured in monetary terms, from investment in a health intervention and weighing that benefit against its cost (benefit-cost analysis [BCA)]. BCA enables comparison of the attractiveness of health investments relative to those in other sectors.

CEAs predominate among economic evaluations in surgery (and for health interventions more generally). Recent overviews of CEA findings for cardiovascular, respiratory, and related disorders (CVRDs) underpin this chapter’s conclusion that many CVRD policies and interventions are highly cost-effective even in resource-constrained environments (also see PAHO/DCP3 companion volume (Alkire, Vincent, and Meara 2015; Chao and others 2014; Legetic and others 2016; Prinja and others 2015; Shroufi and others 2013; Suhrcke, Boluarte, and Niessen 2012). Chapter 19 of DCP3 Volume 5 also looks at the cost-effectiveness of CVRD interventions (Gaziano and others 2017).

The Lancet Commission on Investing in Health applied BCA to broad investments in health and found benefit-cost ratios often in excess of 10 (Jamison and others 2013). Copenhagen Consensus for 2012 used BCAs to rank selected CVRD interventions among the top 15 in a list of 30 attractive priorities for investment in development across all sectors (Kydland and others 2013).

ECEAs remain a relatively new evaluation approach. In chapter 20 of this volume, Watkins and coauthors apply ECEA to several CVRD interventions in different settings and find substantial financial protection benefits (Watkins, Nugent, and Verguet 2017).

From: Chapter 1, Cardiovascular, Respiratory, and Related Disorders: Key Messages and Essential Interventions to Address Their Burden in Low- and Middle-Income Countries

Cover of Cardiovascular, Respiratory, and Related Disorders
Cardiovascular, Respiratory, and Related Disorders. 3rd edition.
Prabhakaran D, Anand S, Gaziano TA, et al., editors.
© 2017 International Bank for Reconstruction and Development / The World Bank.

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