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Amanuel Yigezu
Health Economist  |  Ethiopia
There is a program in my country which have started a decade ago. The government want to conduct economic evaluation of that program in a health facility. The program has both curative and preventive interventions for primary health care (vaccination, de-worming, family health, health education and others). 1. This is not a new intervention and we are concerned on what comparator to use. is "do nothing" comparator useful for a program which has started 10 years back? or do you think that it is possible to have a comparison of the program over time with out having a cost data of the past? what implication can we tell from the comparator for policy recommendation? 2. is it possible for us to use a DALY/LYG to for those curative and preventive measures, as a package? 3. is that feasible to use a model (markov or decision tree model) for a program with a lot of interventions (over 10 interventions)? Thank you so much for your comments ahead!

Expert Replies:

Yot Teerawattananon

Senior Researcher  |  Thailand  |   Replied: 11 Jun 2019 at 22:14
Thank you for raising these very practical questions. I am sure that a lot of people will benefit from your questions. First, you can conduct an economic evaluation for a policy that has been implemented a decade ago. What should be the comparator(s) depending on the policy question in conducting this economic evaluation. If decision makers want to know whether they should continue support this policy, then the comparator can be ‘do nothing’ but you should try to determine key parameter(s) contributing to value for money of this policy especially parameters that can be changed overtime such as incidence or prevalence of the infection. This is to know when (at which level of disease incidence/prevalence) the policy is not worthwhile continuing. If the policy question is how to improve the policy, then comparator(s) should be the new policy options (e.g. modified policy). You can have both types of comparators, if the policy questions include both options described above. Second, DALY or QALY can be used to quantify the impact, if feasible. This is to support allocative efficiency. Third, Markov model or decision tree can be used for such evaluation if there is no data on QALYs gained or DALYs averted from the current policy evaluation. However, please ensure that you make the best use of the information from the impact evaluation of the current policy in the model rather than getting parameters from literature. Please kindly consult our similar experience in Myanmar from this paper. https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/from-design-to-evaluation-applications-of-health-technology-assessment-in-myanmar-and-lessons-for-low-or-lower-middleincome-countries/AC8F0B45857A36E3EC2FAD8FDDBEE516

Amanuel Yigezu

Health Economist  |  Ethiopia  |   Replied: 07 Sep 2019 at 21:15
Dear Yot Teerawattananon,
Thank you very much for your response.

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Yot Teerawattananon

Senior Researcher
Health Intervention and Technology Assessment Program (HITAP)