COUNTDOWN Louis Niessen - Launch 2015
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This document discusses balancing efficiency and equity in health economics. It summarizes Louis Niessen's background and involvement in projects related to neglected tropical diseases. These projects aim to provide evidence on the socioeconomic impact and cost-effectiveness of scaling up control and elimination efforts for neglected tropical diseases. The goal is to reduce morbidity, mortality, and poverty associated with these diseases through increased knowledge and evidence to inform sustainable and equitable scale-up strategies.
COUNTDOWN Louis Niessen - Launch 2015
- 1. HEALTH ECONOMICS, MST3: BALANCE of EFFICIENCY & EQUITY Louis Niessen MD Reg PH PhD Chair of Health Economics, LSTM/JHSPH
- 2. Involvement Investment Cases 1. Member for Equity & Efficiency WHO WG Investment for Impact in the control of neglected tropical diseases - under STAG NCDS, lead C Fitzpatrick, WHO. TOR 2. Member Erasmus Group, BMGF: Estimating the socio-economic impact of achieving the London declaration targets on neglected tropical diseases 3. COUNTDOWN Programme of implementation research to inform the effective and sustainable scaling-up of integrated neglected tropical disease control initiatives Earlier: WHO-CHOICE; Child Survival (IMCI, GAPP); vaccines (GAVI) Results: Poor & Malaria 18yr-cohort PMI-CDC; Poor & NCDs 24yr-Matlab,BD Other networks: HTAi, GENI, IHEA, ISPOR, IEA,
- 3. Background Poverty And Disease • Catastrophic health expenditure + loss of household income cause poverty • Half of the poor are poor because of illness, increasing with sophistication of health care • Also in advanced settings (EU, USA) health systems are regressive: burden of disease and finances falls to low SES. To do: Universal health coverage is about choosing efficient package AND equity impact i.e. willingness to subsidize others to provide protection against catastrophic expenditure
- 4. Background Health Economics Approach 2.5 Towards an investment case for NTDs under UHC Three-step process: 1) categorize services into priority classes 2) expand coverage for high-priority services to everyone 3) ensure that disadvantaged groups are not left behind. 2.5.1 The investment case based on cost−effectiveness 2.5.2 Towards an investment case including equity
- 5. Background Health Economics Approach 1. WHO’s Guidance for Priority Setting in Health Care, or GPS-Health, offers equity criteria for “priority classes” to be considered in addition to cost−effectiveness analysis. 2. Disease criteria: severity of disease, capacity to benefit and past health loss; Specific groups: socio-economic status, area of living, gender, etc; Non-health consequences: financial protection, economic productivity & care for others. 3. Presence of multi-criteria approaches (MCDA) to priority-setting in health, also emerging within NTD world. 4. Will the NTD community use socioeconomic / non-health evidence to inform policy?
- 6. Equity: Conceptual Terms Many vulnerable groups and definitions of vulnerable groups Distributional concepts: Horizontal and vertical equity (Socrates) Inequalities (UK), disparities (USA) (J Tinbergen, J Rawls) Fairness and willingness-to-subsidize (A Sen, D Kahneman) Capability approach (overarching concept: A Sen)
- 7. Policy making & priorities setting in health (A4R, Daniels) Severity of disease Average population health Ease of implementation Emergency situations Burden of disease Economic growth Irresponsible behaviour Vulnerable populations Budget impact Disease of the poor Cost - effectiveness Rational Priority Setting Rank ordering of interventions 1. 2. 3. 4. 5. 6. 7. 8. Multi - criteria decision analysis Burden of disease analysis Cost - effectiveness analysis Equity analysis Evidence - based medicine Severity of disease Average population health Ease of implementation Emergency situations Burden of disease Economic growth Irresponsible behaviour Vulnerable populations Budget impact Disease of the poor Cost - effectiveness Rational Priority Setting Rank ordering of interventions 1. 2. 3. 4. 5. 6. 7. 8. Multi - criteria decision analysis Burden of disease analysis Cost - effectiveness analysis Equity analysis Evidence - based medicine Summary measure: health adjusted life expectancy
- 8. Balancing Equity & Efficiency in National Policy Ongoing multi-country studies Brazil China Cuba Uganda Norway Nepal 0 0.2 0.4 0.6 0.8 1 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1Equity Efficiency Value in Health. 2012 May;15(3):534-9.
- 9. Health Economics Research Theme In MDA Scale-up Integrated Complementary Strategy Theme ICST 1 ICST 2 Liberia GhanaCameroon MDA Scale-up Themes (MST 1 – 3) elimination Country & context-specific setting of MDA MST 1: Evidence synthesis Paul Garner and Cochrane group MST 2: Applied social science Sally Theobald and Margaret Gyapong MST 3: Health economics Louis Niessen and Health Economcs Unit scale-up in Nigeria
- 10. COUNTDOWN Questions And MST 3 Answers Q1) What are effective, cost-effective, sustainable and acceptable current and complementary strategies for scale-up? MST3 Health economics: household impact through population surveys &, routine data, and costing studies; can be combined with MST1-2 Q2) What generalizable factors influence the acceptance, effectiveness, efficiency, and equity impact of scale-up within the health system? MST3 Health economics: economic outcomes adjusted for other qualitative and quantitative findings; can be combined MST2 Research uptake (EE2P): Evidence for priority setting for national programmes based on equity and efficiency
- 11. Example: Historical And Future Population Scenarios NTDs ? PC NTDs ONCH LF SCH STH TRA BOD projections by age and sex Counterfactual London Declaration targets
- 12. Example: Socio-economic Impact Of Control Or Elimination Of Five Neglected Tropical Diseases - Literature Review And Societal Costs (Lenk EJ. Erasmus ,ASTMH, 2014) Aim: Economic impact of meeting the targets for the five diseases eligible for MDA: lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis, and trachoma. Methods A systematic literature review to identify empirical costs related NTDs, including out of pocket payments (OPP), productivity loss, and impoverishment. Cost estimates per person are combined with population projections suffering from clinical manifestations per NTD, country, and year, for the periods 2011-2020 and 2021- 2030, comparing to business-as-usual scenarios. Results Averted burden: productivity loss associated for about 3% for infestation & mild symptoms, about 15% for more severe manifestations (lymphedema and hydrocele), and up to 38% -79% for severe vision loss & blindness. Income loss averted reaching the LONDON goals may amount to US$240 billion for 2011-2020 and US$390 billion for 2021-2030, excluding OPPs & productivity loss due to deaths. Soil-transmitted helminthiasis accounted for approximately half of this amount.
- 13. Intended Impact And Pathways To Achievement IMPACT: Reduced morbidity, mortality, and poverty associated with NTDs through increased knowledge and evidence for cost effective scale- up and sustainable control and elimination of NTDs as a public health problem Community Global Regional National District
- 14. IMPACT: Value-for-Money in COUNTDOWN Value-for-money = cost-effectiveness selected interventions & equity gains in access, coverage, finance Expected outcomes 1. Increased coverage / access among target populations: 2. Enhanced equity by socio-economic group, gender, geography, through reduced exposure reduction, out-of-pockets expenditure, and .. 3. Affordable scale-up budget impact estimates for national investments and other financing sources Expected contributions: national & international policy 1. Evidence for prioritization most attractive – value-for-money- options in NTD control 2. Evidence and advocacy to include equity criteria in NTD decisions