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Economic Evaluation in Global Health Syllabus

Course Learning Objectives

  • Examine the rationale and methods for conducting economic evaluations of global health interventions.
  • Critically evaluate published papers in the field of global health economic evaluation.
  • Identify sources for model parameters including costs and epidemiologic data.
  • Analyze the theoretical rationale for disability adjusted life years (DALYs) and willingness-to-pay thresholds.
  • Participate in the design and conduct of health economic evaluations in collaboration with health economists or mathematical modelers.

Module Learning Objectives

Module 1: Introduction and Rationale for Economic Evaluations for Health Interventions

  • Examine the rationale for conducting economic evaluations of global health interventions.
  • Explore the theoretical foundation for economic evaluations, including cost effectiveness analyses.
  • Describe the economic impact of colonialism on the willingness to pay for global health interventions.

Module 2: Methods for Conducting Economic Evaluations

  • Calculate and interpret an incremental cost-effectiveness ratio (ICER).
  • Explain the different types of economic evaluations.
  • Define economic concepts including opportunity cost and discounting.
  • Examine the theoretical foundation and current debate around willingness to pay thresholds.
  • Apply standard guidelines for reporting economic evaluations in the published literature.

Module 3: The Numerator: Identifying and Measuring Costs for Economic Evaluations

  • Compare the rationale between choosing different payer perspectives and time horizons.
  • Explain how to identify, measure, and value costs for economic evaluations.
  • Gain familiarity with how costs are categorized (e.g., capital vs recurrent, fixed vs. variable, economic vs. financial).
  • Calculate how to annualize fixed costs over their years of useful life.
  • Explain the benefits and drawbacks of different approaches for costing including microcosting and gross costing.
  • Define the rationale for conducting time in motion observation.

Module 4: Examples of Costing Analyses in Global Health

  • Explain the rationale and principles of the Global Health Costing Consortium (GHCC) Reference Case.
  • Apply costing methods to specific health interventions.
  • Gain familiarity with how time and motion observation is used to inform productivity assumptions in cost estimation.
  • Determine how to adapt costs from a research study to reflect those of a government program.
  • Describe the steps for conducting a microcosting of a global health intervention including creating costing plans and templates, dividing an intervention into activities/resource categories, and interviewing staff to obtain cost estimates.

Module 5: The Denominator: Estimating Health Benefits for Economic Evaluations

  • Understand Describe the rationale behind using QALYs and DALYS for health economic evaluation.
  • Gain familiarity with the underlying assumptions of QALYs and DALYs.
  • Explain the methods for estimating utility and disability weights, including direct methods (visual analogue scale, standard gamble, and time trade off) and indirect methods (multi-attribute utility assessment).
  • Analyze how utility measurements can be estimated through disease-specific assessments or domains of health.
  • Explain why different methods of measuring utility produce different estimates.
  • List the pros and cons of using different methods of utility measurement.
  • Understand the benefits and drawbacks of using utility preferences patients vs. the general population.

Module 6: Decision Analysis and Introduction to Modeling (Open-Source Models)

  • Apply decision analysis techniques as it applies to economic evaluation.
  • Define the role of modeling in economic evaluations.
  • Explain the steps of building a decision tree and analyzing the tree to calculate the expected value of different alternatives.
  • Define the different types of sensitivity analyses.
  • List the recommendations for Good Decision Modeling Practices.
  • Describe the rationale behind model validation, and model debugging.

Module 7: Markov and Microsimulation Models

  • Define the role of Markov modeling in economic evaluations.
  • Articulate how Markov models use a matrix of transition probabilities to distribute a cohort into different health states over time.
  • List the assumptions made in Markov modeling.
  • Explain how costs and health outcomes are accumulated in a Markov model.
  • Define the steps in designing, parameterizing, and running a Markov model.
  • Describe the rationale and methodology for conducting probabilistic sensitivity analyses (PSAs).

Module 8: Dynamic Models (Finding Model Inputs from the Literature/Other Sources, Adapting RCT Data for Models, Geospatial Modeling)

  • Explain the difference between deterministic and stochastic models.
  • Gain familiarity with the commonly used distributions for stochastic model parameters.
  • Analyze the structure and rationale behind utilizing linear microsimulation models, compartmental dynamic models, and individual-based dynamic models for economic evaluations.
  • Describe the basic structure of a Susceptible Infected Recovered (SIR) model and explain how it accounts for infectious disease dynamics.
  • Define the basic reproductive number (R0) and understand how public health measures can reduce R0.
  • Demonstrate the process of model calibration and validation.
  • Locate and select appropriate how to find model inputs from the literature and other sources to parameterize models.

Module 9: Budget Impact Analysis (BIA)

  • Describe the rationale and methodology for conducting budget impact analyses.
  • Explain the differences between a budget impact analysis and a cost-effectiveness analysis in terms of overall goal, methods, and outcomes assessed.
  • Identify the steps of performing a BIA.
  • Evaluate how models are used in BIAs.
  • Recognize the characteristics of good quality BIAs in the literature.

Module 10: Special Topics in Economic Evaluation

  • Explain Extended Cost-Effectiveness Analysis (ECEA) and how it can be used for priority settings.
  • Define Discrete Choice Experiments (DCEs).
  • Examine how Distributional Cost-Effectiveness Analyses (DCEAs) assesses the impact of healthcare interventions on different socioeconomic groups.