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8/11/2019 Evaluasi Ekonomi Program Kesehatan 311011
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Evaluasi Ekonomi Program Kesehatan
KMPK 31.10.11
Ari Probandari
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pa a eva uas e onom
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The com arative anal sis of alternatives courses
of action in terms of both cost and
consequences
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Programme ACost A
Consequences A
Choice
Comparator BCost B
Consequences B
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Partial vs Full Economic Evaluation
no yes
Are both costs (inputs) and consequences (outputs) of the alternatives examined?
noExamines only
consequences
Examines
only cost
PARTIAL EVALUATION PARTIAL EVALUATION
Is there
comparison
Outcome
description
Cost
description Cost-outcome description
more
alternatives
?
yes Efficacy orCost minimization analysis
Cost effectiveness analysis
PARTIAL EVALUATION FULL ECONOMIC EVALUATION
effectiveness
evaluation Cost Analysis
Cost utility analysis
Cost benefit analysis6
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engapa eva uas e onom
diperlukan?
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memproduksi semua output yang kita inginkandan butuhkan.
Perlu membuat keputusan rasional
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Assess wether
interventions achieve
Assess whether the
interventions meet
maximum output in a
certain level of input or
objectives, which improve
the welfare of one person
output with less input.
welfare of another.
Source: Glossary of Frequently Encountered Terms in Health Economics.http://www.nlm.nih.gov/nichsr/edu/healthecon/glossary.html
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Type of study Cost Identification of
consequences
Consequences
Cost
minimization
analysis
Dollars Identical None
Cost
effectivenessanalysis
Dollars Single outcome, common
to both alternatives, butachieved in different
Natural units (e.g. life
years gained, disability-days saved, points of
,
etc)
Cost utilityanal sis Dollars Single or multipleoutcome not necessar DALY or QALY
common to both
alternative
Cost Benefit Dollars Single or multiple Dollars
Analysis outcome, not necessarycommon to both
alternative
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Bia a an dihitun adalah o ortunit cost
(biaya kesempatan) Biaya kesempatan adalah the value of
opportun ty orgone, str ct y t e estopportunity forgone, as a result of engaging
.(http://www.nlm.nih.gov/nichsr/edu/healthecon/glossary.html#Cost, 2011)
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Incremental costs
Fixed costs
Total costs
Indirect costs
vo e cos s13
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perhitungan biaya: perspektif penyedialayanan kesehatan ataukah perspektif
masyarakat?
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Sensitization and mapping of DOT
Training
Routine interaction with/supervisionof providers
Dru s
Other visits for patient monitoring Defaulter tracing
Health education for patients
Sputum smears for screening anddiagnosis
Sputum smears for monitoring
X-rays
Programme Management
Wasor
Beyond project expenditure
Other diagnostic tests
Routine interaction with PRM healthcentre
Visits by detailers/TB programmers
NTP and KNCV Staff involvement
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Biaya pasien Biaya pendamping ranspor a ons
Consultations (outpatient)
Hospitalization
Investigations (laboratory, X-ray,
ranspor a on
Time taken to accompany patient
Wages lost
Days lost from studies (e.g.. .
Drugs
Time taken to access treatment
Wages lost by patient
Other
Days lost from studies (e.g.school/college) by patient
Interest paid on loans
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Tergantung dari jenis evaluasi ekonomi yang
akan dilakukan
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An economic evaluation in which the cost
and consequences of alternativeinterventions are expressed cost per unit
(http://www.nlm.nih.gov/nichsr/edu/healthe
con/glossary.html, 2011) Evaluasi ekonomi antar beberapa
alternatif dengan tingkat konsekuensian berbeda teta i da at dibandin kan
dengan satu ukuran keluaran. Perbandingan dinyatakan dalam rasio
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- .
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,
Data sekunder (laporan keuangan, databa ian enun an umum dst.
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berhasil disembuhkan melalui implementasiPPM-DOTS di RS dan PS
Penurunan keterlambatan diagnosis dan
pengobatan melalui PPM DOTS
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measure
Logan et al (1981) Treatment of mmHg blood
Schulman et al
(1990)
Treatment of
hypercholesterolemi
% serum cholesterol
reduction
Hull et al (1981) Diagnosis of deep-
vein thrombosis
Cases of DVT
detected
Sculpher and Buxton(1993)
Asthma Episode-free days
Mark et al (1995) Thrombolysis Years of life gained
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Melakukan penelitian (menggali data primermau un sekunder
Memakai data dari literatur yang ada (review
atau metaanalisis
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Cost
600,000
hospital referral
ACER of PPM
DOTS hospital
ICER of PPM DOTS in community
health centre only = 4,000
200,00
0
= 2,000PPM DOTS in community health
centre only
0
Effectiveness200 300
ACER of PPM DOTS in community health centre only =1,000
succesfully
treated)
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Handlinguncertaintyinhealth
economic
evaluation
Uncertainty
relatedto
data
inputUncertainty
relatedto
extrapolationUncertainty
relatedto
analysis
method
PresentingCIofCER forsampled
data
Whendataisextrapolatedor
modelled
Ex.presentingresultswith
different
discount
Calculation
of
power
to
adjust
adequacy
of
sensitivityana ysis rate.
z
Source: Drummond MF, & Jefersson TO. Guidelines for authors and peer reviewers of economicsubmissions to the BMJ. BMJ 1996; 313: 275.
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between
inputs
and
consequences,
varying
.
sodoing,sensitivityanalysisteststhe
itemsaroundwhichthereisuncertainty.
. . .
on/glossary.html,
2011
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em an ng an a au e p an engan ng a
effectiveness yang sama, untuk mencari mana yangmembutuhkan paling sedikit resources.
Bentuk khusus dari CEA (CEA dengan ukuran efektivitas
yang besarnya sama)
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orm o econom c s u y es gn n w c
interventions which produce different consequences,in terms of both uantit and ualit of life.
Pada CUA, quality of life dan morbiditas
diperhitungkan sebagai outcome dari program. ost per qua ty a uste e years atau cost
per DALY (disability adjusted life years)
life years gained as a result of healthinterventions/health care programs with a judgment
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a ou e qua y o ese e years
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dengan program yang lain mungkin berbeda. Dalam satu ro ram mun kin ada lebih dari 1
outcome.
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A method of comparing the monetary value ofall benefits of a ro ect with all costs of that
project
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uang.-
sebagai Net Social Benefit (NSB)
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prevention/treatment/control, which would be incurred by thehealth service or patient or society at large
Indirect benefit: roduction losses which would have occurredas a result of death, or incapacity or reduced productivity,including through interrupted education, which have now been
avoided n ang e ene , .e. pa n, anx e y or o er re uc on n qua y
of life, either in patients or their relatives and friends, which hasnow been avoided
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Metode untuk mengukur benefit dalam nilai uang
Whose
judgement?
How it is elicited Example
Policy-makers/public Explicit/stated preference e.g. court orders: how much is paid in
Implicit in
decisions/revealed
e.g. legislation on road safety: how much is
spent on it
Individuals
(patients or
Direct
survey/stated
Willingness to pay (WTP)
surveys, e.g. contingent
you pay to avoid X condition?
e.g. conjoint analysis: ranking
attributes to ascertain
preference and WTP
behaviour/revealed
preference
. . ,
payments
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- -
health benefits by directly eliciting individualpreferences in the views of samples of the
general public who are asked how much they
would be prepared to pay to accrue a benefitor o avo cer a n even s.
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