METHODOLOGICAL APPROACHES FOR C EFFECTIVENESS …

1 MMETHODOLOGICAL APPROACHES FOR ETHODOLOGICAL APPROACHES FOR CCOSTOST EFFECTIVENESS ANDEFFECTIVENESS AND CCOSTOST UUTILITY ANALYSIS OF INJURY TILITY ANALYSIS OF INJURY PPREVENTION MEASURESREVENTION MEASURES METHODOLOGICAL APPROACHES for cost EFFECTIVENESS and cost utility analysis of injury prevention measures Editors Suzanne Polinder, Hidde Toet, Martien Panneman and Ed van Beeck iii ABSTRACT Economic evaluation plays an increasing role in prioritising the implementation of the treatment and prevention of both unintentional and intentional injuries.

2 Policy-makers and decision-makers generally need information about the EFFECTIVENESS of an intervention in relation to its costs to assess whether an intervention provides good value for money. A review of the literature has shown that few methodologically robust and comparable studies have been undertaken in the field of injury prevention. This document has been written to provide step-wise guidance on the use of standardized methods to conduct cost- EFFECTIVENESS and cost-utility analyses on injury prevention interventions, thereby contributing to a larger body of such evidence.

3 The added value of this guide is that it links general guidelines on economic evaluation studies to a step-by-step guide for performing economic evaluation studies of injury prevention interventions. It focuses on the specifics of health outcomes and costs in injury prevention. It is hoped that the framework provided in this document will assist public health experts, researchers and policy-makers who are interested in estimating the cost EFFECTIVENESS and cost utility of injury prevention programmes.

4 The use of this document will hopefully contribute to increasing the evidence base of economic evaluations of injury prevention programmes in the European Region. Keywords Injury economics Injuries prevention and control Violence Prevention and control Costs EFFECTIVENESS and utility analysis Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen , Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site ( ).

5 World Health Organization 2011 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

6 Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication.

7 However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. iv Contents ABBREVIATIONS .. VII ACKNOWLEDGEMENTS .. VIII EXECUTIVE SUMMARY .. IX 1. INTRODUCTION .. 1 1 RATIONALE FOR ESTIMATING THE COST EFFECTIVENESS OF INJURY PREVENTION 2 AIM AND 2.

8 GENERAL CONCEPTS AND CONCEPTUAL 6 6 INJURY PREVENTION 6 ECONOMIC 7 COST EFFECTIVENESS 8 COST BENEFIT 8 COST UTILITY 9 COST MINIMIZATION 9 GENERAL CONCEPT: SETTINGS VERSUS TYPES OF 10 CONCEPTUAL FRAMEWORK 10 3. STUDY DESIGN .. 13 13 CONCEPTUAL MODEL OF THE 14 15 INJURY INCIDENCE 18 EXISTING TYPES OF ANATOMICAL CLASSIFICATION BY LOCATION AND TYPE OF 19 INTERNATIONAL CLASSIFICATION OF 19 BARELL INJURY DIAGNOSIS 20 EUROCOST INJURY DIAGNOSIS CLASSIFICATION 20 4.

9 ESTIMATING THE HEALTH EFFECTS OF THE INTERVENTION .. 25 25 COST EFFECTIVENESS ANALYSIS ESTIMATING 26 COST UTILITY ANALYSIS ESTIMATING 27 COST BENEFIT ANALYSIS ESTIMATING 39 5. ESTIMATING THE COSTS OF THE 40 40 IDENTIFYING COST CATEGORIES: DIRECT AND INDIRECT 40 INTERVENTION 43 v DIRECT HEALTH CARE 43 INDIRECT NON HEALTH CARE COSTS: PRODUCTIVITY 48 6. COMPARING COSTS AND EFFECTS: COMPUTING THE INCREMENTAL COST EFFECTIVENESS RATIO .. 54 CALCULATING THE COST EFFECTIVENESS 54 INCREMENTAL COST EFFECTIVENESS 54 INCREMENTAL COST EFFECTIVENESS 57 7.

10 ANALYSIS OF DATA: ADJUSTING FOR TIMING AND UNCERTAINTY .. 59 59 59 UNCERTAINTY IN ECONOMIC EVALUATION 60 THREE TYPES OF 60 SENSITIVITY 61 8. REPORTING THE RESULTS OF COST EFFECTIVENESS AND COST UTILITY ANALYSIS 67 67 COST EFFECTIVENESS 70 REPORTING UNCERTAINTY 70 REPORTING COST EFFECTIVENESS 71 9. EXAMPLES OF ECONOMIC EVALUATION BY STAGES AND 72 EXAMPLE OF COST UTILITY ANALYSIS: COST UTILITY OF INTERVENTIONS TO REDUCE FALLS AMONG OLDER 72 EXAMPLE OF COST BENEFIT ANALYSIS: COST EFFECTIVENESS OF PREVENTING BICYCLE-SPOKE INJURIES AMONG CHILDREN AGED 2 5 77 10.