Evaluation of Program

- Health Screening

Prof Dr. Maznah Dahlui

University Malaya
Contents

1) Importance of health program evaluation

2) Principles of economic evaluation as a tool for
resource allocation
3) Economic worth of cancer screening programs
4) Examples of health screening evaluation
Public Health

To promote health, prevent

diseases so that people can live
in happiness without financial
burden
 Public Health Interventions
Primary prevention
- Interventions to prevent diseases from occurring
- Heath education to promote healthy lifestyle
- Vaccination to prevent infection
- Quarantine and treatment to prevent outspread of an outbreak

Secondary prevention
- Interventions to prevent complications
- Get prompt treatment upon symptom discovery i.E. Infection
- Screening for early diagnosis and treatment i.E cancer for better qol and
prolonged survival

Tertiary prevention – interventions to restore function

- rehabilitation
Program Development
 Program Development
Steps in coming up with a program

Health Issues
1. An intervention or a program is developed to
overcome identified health issues
2. A program must first decide on its objective(s)
3. Subsequently, a plan on how to meet the
objective(s) would be developed Objective

4. The plan consists of the activities that can help

meet the objective(s)
5. Upon implementation, we need to determine Evaluation Planning
whether the objective(s) is met
6. Evaluation is actually performed at various steps
7. Data is needed at every steps
Implementation
Program Evaluation
 Evaluation of Health Interventions
- purpose
 Evaluation of interventions (program/project/policy) is
performed for various reasons;

 To measure the effectiveness of the intervention

 To determine the feasibility of implementation
 To assess the acceptance and accessibility by the targeted group
 To know the cost implications
 To determine whether the program is sustainable
 To decide on which intervention among several interventions with
the same objective would give the highest return of investment
Uses of Health Program Evaluation
 Insight – on the needs, barriers and activities
 Improvement
 Social mobilization
 Inter-sectoral coordination
 Implementation
 Client conveniences
 Outcome/impact
 Skill development
 Behavioral change
 Level of success in achieving objectives
 accountability
 Types of Evaluation

 Formative
 Summative These are sequential and built on
each other (cannot do impact
 Outcome evaluation without evidence of
positive outcome)
 Impact
 economic
 Outcome evaluation

 Measures overall effectiveness of the program

based on the set specific objectives
 Example:
- the number of cases detected
- the % of people with behavior change
- the reduction in incidences of diseases
Impact evaluation Economic evaluation

 Measures a longer term  Compare program

program impact in target with similar long term
population
impact to determine
which one is more
cost effective
 Measurement of Effectiveness
 Starts with setting the objective of intervention
 Followed by selection of indicators to determine whether the objective
is met
 Example: To increase survival with better QoL of liver cancer patients
due to hepatitis C infection

Program identified : Screening and treatment of Hep C patients

Indicators : Ab + Hep C with positive RNA treated with DAA

 Example : To prevent death from complications of Diabetes Mellitus

 Program identified : regular health check ups

 Indicators : measurement of blood glucose and HbA levels
 Feasibility of program

 Need to know whether a planned intervention is practical

 In terms of resources – on its availability, provision and sustainability
 Example ;
- procedure of implementation : what are the obstacles?,
customer’s satisfaction
- human resource : is the required expertise available, do we need
to train and how many?
- financial aspect : can the people afford?, Is investment in capital
needed or just operating budget?.
- study methods : qualitative (observation, IDI), surveys, data
compilation, budget impact analysis
 Acceptance and Accessibility

 Health interventions should be developed in consideration of the wants of the

targeted population besides to meet their health needs.
 Example to introduce a community screening program;
- first need to determine which population would benefits more
(certain age, gender, locality and characteristics (betel chewing
population)
- is the intervention culturally accepted (I.e PAP smear)
- can the people afford the registration fee or transport to the health
facilities
 Economic Evaluation

Economic evaluation is performed ….

 To know the cost implications
 To decide on which intervention among several
interventions with the same objective is most cost-
effective and provide the highest return
 To determine whether the program is worth invested in
 To ensure that the program could be sustained
 Money
Resources
needed for
Healthcare
 Man Personnel Equipment
 Money
 Materials
 Minutes (Time) Facilities

 Management (System)

Health Program

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Budget is limited, and because of that
we have to make the right decision on
spending for healthcare.

Doctors are tight up when comes to

providing the best treatment to patients
especially if the drug is expensive.

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 Why do we need rationing in resource allocation?

NHMS: Demand in healthcare

2016
2006
1996

Kernick D P. (2003) Introduction to health economics

for the medical practitioner. Postgrad. Med J: 79 147-150
Given the various option, we often are
unsure which is the best treatment for
patients

We need some clues to guide us in making

the decision.

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 • The study on healthcare
system, health financing, health
as a commodity in a non
Health competitive market and about
Economics economic evaluation of
healthcare.

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 • Inform care providers and patients about the best
available research evidence
• Aims to measure efficiency or the value of money
Cost
Health effects
utilised on one health intervention programme in
comparison to another
Economic • Advice to decision-makers or stakeholders on health
evaluation care intervention programme
• Help in the healthcare resources allocation.

Weighing up

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 Economic Evaluation
EE is not about But to determine which intervention
comparing the cost and among several interventions with the same
benefit of a program, goal is more cost-effective.

Program A

Cost Program B

Cost versus Benefits Looking for the more cost-effective

intervention

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https://www.youtube.com/watch?v=sACM-0NV1p4&rel=0

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 Economic evaluation- relating the costs and benefits of
alternative ways of delivering health care

Kernick D P. (2003) Introduction to health economics for the medical practitioner. Postgrad. Med J: 79 147-150

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 1. Comparison of same intervention/treatment in different
population groups

Kernick D P. (2003) Introduction to health economics for the medical practitioner. Postgrad. Med J: 79 147-150

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 2. Comparison of different interventions/treatments in
particular disease

Intervention Annual programme Outcome Cost per death

cost (no of deaths averted
averted)
Spraying breeding 10,000 $ 60
site 167 $

Insecticide treated 4,000 $ 34 118 $

bed nets

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 3. Comparison of some competing
interventions/treatments
Intervention Cost per life year saved (£)

Blood pressure reduction 1,000

Counselling for activity 3,000

Coronary care units 4,900

Breast screening 8,400

Cervical screening 9,000

Neonatal intensive care 11,500

Haemodialysis 27,000
Kernick D P. (2003) Introduction to health economics for the medical practitioner. Postgrad. Med J: 79 147-150

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 4. Comparison of resource allocation across sectors

Cancer screening vs building a dam/high way

 Can be done by using cost benefit analysis ($/$)

 By measuring all outcomes (benefits) in $

 Direct benefit: savings in future costs of treatment incurred by

individuals and society to avoid disease/death
 Indirect benefit: production loss due to avoided premature
death and disability of cancer

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Examples of Assessing Effectiveness of
Health Interventions

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Evaluating the cost-
effectiveness of
cervical screening

 Pilot project for organized cervical

cancer screening (2012)

 all women aged 20 years old and

above were invited for PAP smear and
received recall to repeat the test.

 A CEA was conducted to determine

which recall method would be most
cost-effective.

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 Calling women for PAP smear via telephone was
the most cost-effective method.

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 Breast Cancer
Screening
Program

 Several studies had been

conducted locally on the
KAP of screening for breast
cancer among women in
Malaysia.

 KAP on breast cancer and

its screening uptake differ
across populations.

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 Breast Cancer
Screening
Program

 We need to know which

population needs more
intervention and

 Whether the current

practice is still relevant or
need to change.

 A cross sectional study

was conducted to assess
the situation.

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 Breast Cancer Screening program

 Breast Self Examination

(BSE) as screening for  Question on whether we
breast cancer and Clinical should follow the practice of
Breast Examination (CBE) mammogram as a national
are still relevant in Malaysia, community screening for
where resources are limited. breast cancer as in
developed countries.
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 Implications of study findings
CEA of Breast Cancer Screening

Mammogram as a community breast cancer screening is not cost-

effective…
An economic evaluation had
been conducted to determine
the cost
The of various
current breast
practice of CBE followed by mammography when
cancer screening
abnormality types in and mammogram of women with risk
is detected,
Malaysia.
factors are cost-effective according to the threshold set by MAHTA
(1 Whether
 GDP peritscapita)
worth for MOH to
provide mammogram as a
Recommendation:
community screeningefforts should be focused on improving the
for breast
participation
cancer. rate for CBE and increasing the budget allocation
for mammogram for the current BC screening program.

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 Conclusion
 Evaluation should be in place when planning to set up a
health intervention program.
 Evaluation of program – for effectiveness, efficiency and
equity.
 Selection of the appropriate method for health
screening determines the cost-effectiveness of the
screening program – depends on the disease type and
population involved.
 For most health interventions, the benefits could not be
seen immediately (long term impact - return of
investment)

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Any
questions ?

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