Training Course on Cost-Benefit & Cost-Effectiveness Analysis in Healthcare

Module 1: Introduction to Economic Evaluation in Healthcare
Foundations of Health Economics
The concept of scarcity and trade-offs in healthcare.
Economic evaluation as a decision-support tool.
Types of Economic Evaluation
Cost-benefit analysis (CBA) – measuring costs and benefits in monetary terms.
Cost-effectiveness analysis (CEA) – comparing costs relative to health outcomes.
Cost-utility analysis (CUA) – incorporating QALYs and DALYs.
Cost-minimization analysis (CMA) – when outcomes are equivalent.
Global Health Perspectives
WHO’s role in economic evaluation and disease burden metrics.
The World Bank’s cost-effectiveness thresholds in low- and middle-income countries.
Applications in Policy and Practice
Choosing between competing health interventions.
Allocating limited resources in health systems.
Case Study: Comparing the economic rationale of investing in primary care vs. hospital expansion.

Module 2: Measuring and Valuing Costs in Healthcare
Types of Costs
Direct medical costs: hospital stays, medications, diagnostics.
Direct non-medical costs: transport, accommodation.
Indirect costs: lost productivity, absenteeism.
Intangible costs: pain, suffering, caregiver burden.
Methods of Costing
Micro-costing: detailed breakdown of every resource used.
Gross costing: aggregated cost data.
Top-down vs. bottom-up approaches.
Cost Data Sources and Challenges
Hospital records, insurance claims, national health accounts, surveys.
Issues with missing, incomplete, or biased data.
Adjusting Costs
Inflation adjustments and cost standardization.
Currency conversions and purchasing power parity (PPP).
Discounting future costs and outcomes.
Exercise: Estimating direct and indirect costs of a national tuberculosis control program.

Module 3: Measuring Health Outcomes
Health Outcomes in Economic Evaluation
Clinical endpoints: survival, recovery, relapse rates.
Intermediate outcomes: biomarkers, risk scores.
Patient-reported outcomes: quality of life measures.
QALYs and DALYs
Calculation and interpretation of QALYs.
DALYs: years of life lost (YLLs) and years lived with disability (YLDs).
Critiques and limitations of QALY/DALY approaches.
Valuation of Health States
Standard gamble, time trade-off, and visual analogue scales.
Instruments: EQ-5D, SF-36, WHOQOL.
Assigning Monetary Values to Outcomes (CBA Specific)
Willingness-to-pay approach.
Human capital method: valuing productivity gains.
Practical Task: Calculating DALYs averted through a childhood vaccination program.

Module 4: Conducting Cost-Benefit and Cost-Effectiveness Analyses
Step-by-Step Process
Defining study objectives and perspective (societal, healthcare system, payer).
Identifying alternatives/interventions.
Measuring and valuing costs and outcomes.
Performing incremental analysis (ICERs).
Decision Rules and Thresholds
Interpreting ICERs in relation to willingness-to-pay thresholds.
WHO’s “three times GDP per capita” rule (and its criticisms).
Presenting and Interpreting Results
CEA league tables.
Cost-effectiveness acceptability curves (CEACs).
Tornado diagrams and cost-effectiveness planes.
Dealing with Uncertainty
Sensitivity analyses: one-way, multi-way, probabilistic.
Scenario analysis and Monte Carlo simulations.
Simulation Exercise: Groups conduct a simplified CEA comparing two antimalarial treatment regimens.

Module 5: Applying Results to Policy and Practice
Policy Relevance of Economic Evaluation
Informing health benefits packages.
Guiding donor and government investment decisions.
Resource allocation in epidemics and emergencies.
Equity and Ethical Considerations
Distributional cost-effectiveness analysis (DCEA).
Balancing efficiency vs. fairness in resource-limited settings.
Communication of Results
Writing policy briefs for decision-makers.
Translating technical findings into actionable recommendations.
Real-World Applications
Cost-effectiveness of ART programs in HIV/AIDS.
Economic evaluation of COVID-19 interventions.
Maternal and child health program analysis.
Capstone Project
Each group selects a real or hypothetical intervention.
Conducts a mini cost-effectiveness or cost-benefit analysis.
Presents findings and recommendations in a policy brief format.