Advances & methods to conduct cost-effectiveness analysis for health communication

1. Advances & methods to conduct cost-effectiveness analysis for health communication Paul Hutchinson, Ph.D. Summative Evaluation Unit, Department of International Health & Development, Tulane University School of Public Health & Tropical Medicine,

2. Cost-effectiveness analysis in every day life “Because it is a rare calling, you do have to reach out to the masses. There’s nothing more cost-effective. Without the Internet, this wouldn’t be possible.”

3. Cost-effectiveness analysis in every day life “Because it is a rare calling, you do have to reach out to the masses. There’s nothing more cost-effective. Without the Internet, this wouldn’t be possible.” Natalie Smith, founder, www.Vocationsplacement.org, Internet site that matches individuals with monastic orders

4. Health communication cost-effectiveness: Determining the “bang for the buck”† • How can we make sure that we are getting the most behavior change for our program dollar? • Can we alter the mix of different communication sub-interventions to achieve greater gains? • Can we demonstrate that health communication interventions are a bargain relative to the alternatives?

5. Economic Evaluation Methods Cost-effectiveness analysis: Evaluates health gains (in a common unit) relative to their costs. Economic Evaluations Intermediate Output Final Cost Effectiveness $ per behavior change $ per HIV infection averted $ per (smoking) quitter $ per new condom user Cost Utility $ per DALY saved $ per QALY Cost (Minimization) $ per capita $ per person reached Sources: Drummond, Sculpher, Torrance, O’Brien, & Stoddart 2005; Creese et al 2002

6. Costs Capital/recurrent Financial/economic Shared costs Price deflation Effectiveness Outcomes Research design Evaluation methods Perspective Time? Sensitivity Attribution What is involved in conducting cost-effectiveness analysis? Is it cost-effective? Sources: Drummond, Sculpher, Torrance, O’Brien, & Stoddart 2005; Creese et al 2002

7. Cost-effectiveness Analyses by Health Area and Intervention Type Source: Hutchinson, P. and J. Wheeler. 2006. “The cost-effectiveness of health communication programs: What do we know?” Journal of Health Communication, 11(Supplement 2): 7-46.

8. Cost-effectiveness Analyses by Health Area and Intervention Type* *Developing countries with appropriate methods Source: Hutchinson, P. and J. Wheeler. 2006. “The cost-effectiveness of health communication programs: What do we know?” Journal of Health Communication, 11(Supplement 2): 7-46.

9. Special Issue of theJournal of Health Communication Volume 11, Supplement 2, November 2006 1 article reviewing existing studies 3 articles outlining appropriate methods for CEA for health communication 4 empirical analyses of the CE of health communication interventions

10. Empirical Analyses

11. Complications in determining effectiveness of health communication • Full coverage • Multiple programs • Non-randomly selected comparison group “In the past six months, have you seen this symbol/message? If yes, where?”

12. Empirical Analyses

13. Cost-effectiveness of Smiling Sun(National Sample) Source: Hutchinson, P. P. Lance, D. Guilkey, M. Shahjahan, S. Haque. 2006. “Measuring the cost-effectiveness of a national health communication program in rural Bangladesh,” Journal of Health Communication, 11(Supplement 2): 91-122.

14. Empirical Analyses

15. Conclusions • It is possible to analyze the cost-effectiveness of health communication interventions • But it is generally not done. • Available evidence from HCP studies indicates that effective programs also tend to be cost-effective