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Cost Utility Analyses in International Disaster Responses—Where Are They?

Published online by Cambridge University Press:  17 May 2012

Richard Zoraster*
Affiliation:
Office of Public Health Studies and Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiUSA
*
Correspondence: Richard Zoraster, MD, MPH Office of Public Health Studies and Department of Surgery John A. Burns School of Medicine University of Hawaii 651 Ilalo Street, MEB Honolulu, HI 96813 USA E-mail rzoraster@yahoo.com

Abstract

International health care providers have flocked to Haiti and other disaster-affected countries in record numbers. Anecdotal articles often give “body counts” to describe what was accomplished, followed months later by articles suggesting outcomes could have been better. Mention will be made that various interventions were “expensive,” or not the best use of limited funds. But there is very little science to post-intervention evaluations, especially with regard to the value for the money spent. This is surprising, because a large body of literature exists with regard to the Cost Utility Analysis (CUA) of health care interventions. Applying reproducible metrics to disaster interventions will help improve performance.

This study will: (1) introduce and explain basic CUA; (2) review why the application of CUA is difficult in disaster settings; (3) consider how disasters may be unique with regard to CUA; (4) demonstrate past and theoretical utilization of CUA in disaster settings; and (5) suggest future utilization of CUA by healthcare providers in Disaster Response.

Zoraster R. Cost utility analyses in international disaster responses—where are they? Prehosp Disaster Med. 2012;27(2):1-6.

Type
Special Report
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

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References

1. Tsunami Evaluation Coalition. The roles of needs assessment in the Tsunami Response. ALNAP 2006. http://ochanet.unocha.org/p/Documents/TEC_Needs_Report.pdf. Updated July 2006. Accessed May 31, 2011.Google Scholar
2. Von Schreeb, J, Riddez, L, Samnegård, H, Rosling, H. Foreign field hospital in the recent sudden-onset disasters in Iran, Haiti, Indonesia, and Pakistan. Prehosp Disaster Med. 2008;23(2):144-151.CrossRefGoogle ScholarPubMed
3. Pan American Health Health Organization. WHO-PAHO Guidelines for the Use of Foreign Field Hospitals in the Aftermath of Sudden-Impact Disasters. Washington, D.C.: Pan American Health Organization; 2003.Google Scholar
4. De Ville de Goyet, C. Health lessons learned from the recent earthquakes and Tsunami in Asia. Prehosp Disaster Med. 2007;22(1):15-21.CrossRefGoogle ScholarPubMed
5. VanRooyen, MJ, Hansch, S, Curtis, D, Burnham, G. Emerging issues and future needs in humanitarian assistance. Prehosp Disaster Med. 2001;16(4):216-222.CrossRefGoogle ScholarPubMed
6. Murray, CJL, Anderson, B, Burstein, R, et al. . Development assistance for health: trends and prospects. The Lancet. 2011; DOI:10.1016/S0140-6736(10)62356-2.CrossRefGoogle ScholarPubMed
7. World Health Organization. CHOosing interventions that are Cost Effective (WHO CHOICE). An overview of the rationale, activities and goals of WHO-CHOICE. http://www.who.int/choice/description/benefits/en/. Accessed June 2, 2011.Google Scholar
8. Banatvala, N, Zwi, A. Public health and humanitarian interventions: developing the evidence base. BMJ. 2000;321:101-105.CrossRefGoogle ScholarPubMed
9. Harvey, P, Stoddard, A, Harmer, A, Taylor, G; ALNAP. The state of the humanitarian system: assessing performance and progress. http://www.alnap.org/pool/files/alnap-sohs-final.pdf. Updated January 2010. Accessed June 2, 2011.Google Scholar
10. Wikler, D. Why prioritize when there isn't enough money? Cost Effect Resource Alloc. 2003;1:5. http://www.resource-allocation.com/content/1/1/5 Published February 26, 2003. Accessed May 31, 2011.CrossRefGoogle ScholarPubMed
11. Schieber, GJ, Gottret, P, Fleisher, LK, Leive, AA. Financing global health: mission unaccomplished. Health Affairs. 2007;26(4):921-934.CrossRefGoogle ScholarPubMed
12. Organization for Economic Co-operation and Development. Paris declaration on aid effectiveness. http://www.oecd.org/document/22/0,3746,en_2649_3236398_36074966_1_1_1_1,00.html. Published 2005. Accessed May 31, 2011.Google Scholar
13. Institute for Health Metrics and Evaluation. Collaborators. http://www.healthmetricsandevaluation.org/research/collaborators. Accessed June 2, 2011.Google Scholar
14. King, CH, Bertino, A. Asymmetries of poverty: why global burden of diseases valuations underestimate the burden of neglected tropical disease. PLoS Negl Trop Dis. 2008;2(3):e209.CrossRefGoogle Scholar
15. Lopez, AD, Mathers, CD, Ezzati, M, Jamison, DT, Murray, CJL. Measuring the global burden of disease and risk factors, 1990–2001. In: Lopez AD, Mathers CD, Ezzati M, et al, eds, Global Burden of Disease and Risk Factors. Washington (DC): World Bank; 2006.CrossRefGoogle ScholarPubMed
16. Hutubessy, R, Chisolm, D, Edeger, TT-T. WHO Choice. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc. 2003;1(1):8 http://resource-allocation.com/content/1/1/8 Accessed May 13, 2011.CrossRefGoogle ScholarPubMed
17. Baltussen, R, Adam, T, Tan-Torres Edejer, T, et al. . Part One: Methods for generalized cost-effectiveness analysis. What is generalized cost-effectiveness analysis?. In: Tan-Torres Edejer T, Bltussen R, Adam T, et al, WHO Guide to Cost-Effectiveness Analysis. Geneva: World Health Organization; 2003.Google Scholar
18. Murray, CJL, Evans, DB, Acharya, A, Baltussen, R. Development of WHO guidelines on generalized cost-effectiveness analysis. Health Econ. 2000;9:235-251.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
19. James, KC, Foster, SD. Weighting-up disability. Lancet. 1999;354(9173):87-88.CrossRefGoogle ScholarPubMed
20. Jamison, DT, Breman, JG, Measham, AR, et al. . EDs Priorities in Health. Washington, DC: The World Bank; 2006.CrossRefGoogle Scholar
21. Lopez, AD, Mathers, CD, Ezzati, M, Jamison, DT, Murray, CJL. Measuring the global burden of disease and risk Factors, 1990-2001. In: Lopez AD, Mathers CD, Ezzati M, et al, eds, Global Burden of Disease and Risk Factors. Washington, DC: World Bank; 2006.CrossRefGoogle ScholarPubMed
22. Fox-Rushby, JA, Hanson, K. Calculating and presenting disability adjusted life years (DALYs) in cost-effectiveness analysis. Health Policy Plan. 2001;16(3):326-331.CrossRefGoogle ScholarPubMed
23. Murray, CJL, Acharya, AK. Understanding DALYs. J Health Econ. 1997;16(6):703-730.CrossRefGoogle ScholarPubMed
24. Mathers, CD, Salomon, JA, Ezzati, M, Begg, S, Lopez, AD. Sensitivity and uncertainty analyses for burden of disease and risk factor estimate. In: Lopez AD, Mathers CD, Ezzati M, et al, eds, Global Burden of Disease and Risk Factors. Washington, DC: World Bank; 2006.Google Scholar
25. Mathers, CD, Vos, T, Lopez, AD, Salomon, J, Ezzati, M, eds. National Burden of Disease Studies: A Practical Guide. Edition 20. Global Program on Evidence for Health Policy. Geneva: World Health Organization; 2001.Google Scholar
26. Murray, CJ, Lopez, A. The global burden of disease: A comprehensive assessment of mortality and disability from disease, injuries, and risk factors in 1990 and projected to 2020. Cambridge: Harvard University Press; 1996.Google Scholar
27. Mathers, CD, Bernanrd, D, Iburg, M, et al. . Global burden of diseases in 2002: data sources, methods and results. GPE discussion paper no. 54. Geneva: World Health Organization; 2003.Google Scholar
28. Bradt, DA. Evidence-based decsion-making in humanitarian assistance. Humanitarian Practice Network. London: Overseas Development Institute; 2009.Google Scholar
29. Disease Control Priorities Project. Priorities in Health. Washington, DC: The World Bank; 2006. http://www.dcp2.org/pubs/PIH. Accessed June 2, 2011.Google Scholar
30. Drummond, M, Sculpher, M. Common methodological flaws in economic evaluation. Med Care. 2005;43:II-5-II-14.CrossRefGoogle Scholar
31. Jefferson, T, Demicheli, V. Quality of economic evaluations in health care. BMJ. 2002;324:313-314.CrossRefGoogle ScholarPubMed
32. Jefferson, T, Smith, R, Yee, Y, Drummond, M, Pratt, M, Gale, R. Evaluating the BMJ guidelines for economic submissions. JAMA. 1998;280:275-277.CrossRefGoogle Scholar
33. Johns, B, Baltussen, R, Hutubessy, R. Programme costs in the economic evaluation of health interventions. Cost Effect Res All. 2003,1:1. http://www.resource-allocation.com/content/1/1/1. Accessed May 5, 2011.Google Scholar
34. Drummond, MF, Jefferson, TO. for the BMJ Working Party on Guidelines for Authors and Peer-Reviewers of Economic Submissions to the British Medical Journal. Guidelines for authors and peer-reviewers of economic submissions to the British Medical Journal. BMJ. 1996;313:275-383.CrossRefGoogle Scholar
35. Mulligan, J, Walker, D, Fox-Rushby, J. Economic evaluations of non-communicable disease interventions in developing countries: a critical review of the evidence base. Cost Effect Res All. 2006;4:7.CrossRefGoogle ScholarPubMed
36. Udvarheiyi, IS, Colditz, GA, Rai, A, Epstein, AM. Cost-effectiveness and cost-benefit analyses in the medical literature. Are they being used correctly? Ann Intern Med. 1992;116:238-244.CrossRefGoogle Scholar
37. Neumann, PJ, Zinner, DE, Wright, JC. Are methods for estimating QALYs in cost-effectiveness analyses improving? Med Decis Making. 1997;17:402-408.CrossRefGoogle ScholarPubMed
38. Evans, DB, Edejer, TT, Adam, T, Lim, S. WHO choosing interventions that are Cost Effective (CHOICE) Millennium Development Goals Team. Methods to assess the costs and health effects of interventions for improving health in developing countries. BMJ. 2005;331:1137-1140.CrossRefGoogle Scholar
39. Baltussen, R, Adam, T, Tan-Torres Edejer, T, et al. . Part One: Methods for generalized cost-effectiveness analysis. What is generalized cost –effectiveness analysis? (Reporting CEA Results). In: Tan-Torres Edejer T, Bltussen R, Adam T, et al, WHO Guide to Cost-Effectiveness Analysis. Geneva: World Health Organization; 2003.Google Scholar
40. Arnesen, T, Kapiriri, L. Can the value choices in DALYs influence global priority-setting? Health Pol. 2004;70:137-149.CrossRefGoogle ScholarPubMed
41. Williams, A. Calculating the global burden of disease: time for a strategic reappraisal? Health Econ. 1999;8:1-8.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
42. Mathers, CD, Murray, CJL, Lopez, AD, et al. . Estimates of Healthy Life Expectancy for 191 Countries in the Year 2000: Methods and Results. GPE Discussion Paper No. 38. Geneva: WHO; 2000. http://www.who.int/healthinfo/paper38.pdf. Accessed April 18, 2012.Google Scholar
43. Hands up for Healthcare Workers. Org. Is Haiti's Health system any better? http://www.merlinusa.org/wp-content/uploads/2011/01/MerlinUSA_Is-Haiti-health-system-any-better.pdf. Merlin; 2011. Accessed June 2, 2011.Google Scholar
44. Chu, K, Stokes, C, Trelles, M, Ford, N. Improving effective surgical delivery in humanitarian disasters: lessons from Haiti. PLoS Med. 2011;8(4):e1001025 DOI:10.1371/journal.pmed.1001025.CrossRefGoogle ScholarPubMed
45. Roy, N, Shah, H, Patel, V, Coughlin, RR. The Gujarat earthquake (2001) experience in a seismically unprepared area: community hospital medical response. Prehosp Disaster Med. 2002;17(4):186-195.CrossRefGoogle Scholar
46. Proudlock, K, Ramalingam, B, Sandison, P. Improving humanitarian impact assessment: bridging theory and practice. ALNAP 8th Review of Humanitarian Action. 2009. http://www.alnap.org/pool/files/8rhach2.pdf. Accessed June 3, 2011.Google Scholar
47. Natsios, A. The clash of the counter-bureaucracy and development. Center for Global Development Essay. www.cgdev.org/content/publications/detail/1424271. Published 2010. Accessed June 2, 2011.Google Scholar
48. Gosselin, RA, Maldonado, A, Elder, G. Comparative cost-effectiveness analysis of two MSF Surgical trauma centers. World J Surg. 2010;34:415-419.CrossRefGoogle ScholarPubMed
49. Easterly, W, Pfutze, T. Where does the money go? Best and worst practices in foreign aid. J Econ Persp. 2008;22:29-52.CrossRefGoogle Scholar
50. Herfkens, E, Bains, M. Reaching our development goals: why does aid effectiveness matter? http://www.oecd.org/dataoecd/43/31/40987004.pdf. Published 2009. Accessed April 18, 2012.Google Scholar
51. Robertson, DW, Bedell, R, Laveru, JV, Upshur, R. What kind of evidence do we need to justify humanitarian medical aid? Lancet. 2002;360:330-333.CrossRefGoogle ScholarPubMed
52. Anand, S, Hanson, K. DALYs: Efficiency versus equity. World Devl. 1998;26:307-310.CrossRefGoogle Scholar
53. Anand, S, Hanson, K. Disability-adjusted life years: a critical review. J Health Econ. 1997:685-702.CrossRefGoogle ScholarPubMed
54. Arneson, T, Nord, E. The value of DALY life: problems with ethics and validity of disability adjusted life years. BMJ. 1999;319:423-425.Google Scholar
55. Tsuchiya, A. QALYS and ageism: philosophical theories and age weighting. Health Econ. 2000;9:57-68.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
56. Tsuchiya, A. Age-related preferences and age-weighting health benefits. Soc Sce Med. 1999;48:267-276.CrossRefGoogle ScholarPubMed
57. Williams, A. QALYS and ethics: a health economists perspective. Soc Sci Med. 1996;43:1795-1804.CrossRefGoogle ScholarPubMed
58. Cantor, SB. Cost-effectiveness analysis, extended dominance, and ethics: a quantitative assessment. Med Decis Making. 1994;14:159-265.CrossRefGoogle ScholarPubMed
59. Brock, DW. Ethical issues in the use of cost-effectiveness analysis for prioritization of health care resources. In: Tan-Torres Edejer T, Bltussen R, Adam T, et al, WHO Guide to Cost-Effectiveness. Geneva: World Health Organization; 2003, p. 289-312.Google Scholar
60. James, KC, Foster, SD. Weighting-up disability. Lancet. 1999;354:87-88.CrossRefGoogle ScholarPubMed
61. World Medical Association. Statement on Medical Ethics in the Event of Disasters. www.wma.net/en/30publications/10policies/d7/index.html. Published 14 October 2006. Accessed April 15, 2011.Google Scholar
62. Ustun, TB, Rehm, J, Chatterji, S, et al. . Multiple-informant ranking of disabling effects of different health conditions in 14 countries. WHO/NIH Joint Project, CAR Study Group. Lancet. 1999;354:111-115.CrossRefGoogle ScholarPubMed
63. Robberstad, B. QALYs vs DALYs vs Lys gained: what are the differences, and what difference do they make for health care priority setting? Norsk Epidemiolog. 2005;15(2):183-191.Google Scholar
64. Reidath, DD, Allotey, PA, Kouame, A, Cummins, RA. Measuring health in a vacuum: examining the disability weight of the DALY. Health Pol Plan. 2003;18(4):351-356.CrossRefGoogle Scholar
65. Zou, S. Applying DALYs to the burden of infectious diseases (letter). Bull WHO. 2001;79(3):267-268.Google Scholar
66. WHO Commission on Macroeconomics and Health. Macroeconomics and Health: Investing in the Health for Economic Development. Report of the Commission on Macroeconomics and Health. Geneva: World Health Organization; 2001.Google Scholar
67. Eichler, HG, Kong, SX, Gerth, WC, Mavros, P, Jonsson, B. Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge? Value Health. 2004;7:518-528.CrossRefGoogle ScholarPubMed
68. Gosselin, RA, Gialamas, G, Atkin, DM. Comparing the cost-effectiveness of short orthopedic missions in elective and relief situations in developing countries. World J Surg. 2011;35:951-955.CrossRefGoogle ScholarPubMed
69. Fernald, JP, Clawson, EA. The Mobilie Army Surgical Hospital humanitarian mission in Pakistan: the primary care experience. Mil Med. 2007;172:471-477.CrossRefGoogle ScholarPubMed
70. Macintyre, A, Barbera, JA, Petinaux, BP. Survival internal in earthquake entrapments: research findings reinforced during the 2010 Haiti Earthquake response. Disaster Med Public Health Preparedness. 2011;5:13-22.CrossRefGoogle Scholar
71. USAID Japan – Earthquake and Tsunami. Fact Sheet #13, Fiscal Year (FY) 2011. http://www.usaid.gov/our_work/humanitarian_assistance/disaster_assistance/countries/Japan/template/fs/fy2011/japan_eqtsu_fs13_03-24-2011.pdf. Published March 24, 2011. Accessed June 2, 2011.Google Scholar
72. Chapman, RH, Berger, M, Weinstein, MC, Weeks, JC, Goldie, S, Neumann, PJ. When does quality-adjusting life-years matter in cost-effectiveness analysis? Health Econ. 2004;13:429-436.CrossRefGoogle ScholarPubMed
73. Laxminarayan, R, Mills, AJ, Breman, JG, et al. . Advancement of global health: key messages from the Disease Control Priorities Project. Lancet. 2006;367:1193-2008.CrossRefGoogle ScholarPubMed
74. Shillcutt, SD, Walker, DG, Goodman, CA, Mills, AJ. Cost-effectiveness in low- and middle-income countries: a review of the debates surrounding decision rules. Pharmacoeconomics. 2009;27:902-917.CrossRefGoogle ScholarPubMed