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Evaluasi Ekonomi dalam


Pelayanan Kesehatan

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Mengapa Evaluasi ekonomi


penting?
n Sumber daya terbatas
n Sumber daya apa? SDM, waktu, fasilitas, peralatan, pengetahuan
n Jadi, harus memilih

n Bagaimana membuat keputusan memilih? Pakai perasaan?

n Pertimbangan harus dibuat dengan terorganisasi, karena:


n Tanpa analisis yang sistematik, sulit untuk mengidentifikasi secara
jelas alternatif pilihan
n Perlu melihat sudut pandang dari mana keputusan tersebut dibuat:
dari sisi rumah sakit, dari sisi pemerintah, dari sisi pihak ketiga
pembayar, dari sisi masyrakat
n Perlu membandingkan antara sumber daya dengan output yang
dihasilkan value for money.

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Health Economic Evaluations Are Just One


Part of Health Economics

Health
Economics
Health
Economic
Evaluation

other topics in health economics:


optimal size of hospitals, optimal payment for
physicians, optimal level of co-payment by patients,.

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Apa artinya evaluasi ekonomi?

n Membandingkan antara input dengan output, membandingkan


antara biaya dengan konsekuensinya

n Pilihan. Bagaimana pilihan secara eksplisit dapat dipilih

comparative analysis of alternative courses of action


in terms of both their cost and consequences

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Konsekuensi A
Cost A Program A

Choice

Cost B Program Konsekuensi B


Komparator B

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Jenis Evaluasi Ekonomi

n Partial economic evaluation

n Full economic evaluation

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Perbedaan Evaluasi Ekonomi


Apakah cost dan konsekuensi diukur?

No Yes
Partial Evaluation
Hanya mengukur Hanya mengukur
konsekuensi biaya
No 1A Partial 1B Partial Partial evaluation
evaluation evaluation
Apakah ada Deskripsi Cost-outcome
perbandingan Gambaran Gambaran Cost
alternatif? outcome
Yes 3A Partial 3B Partial Full economic
evalution evaluation evaluation

Evaluasi Analisis biaya Cost-effectiveness


effectiveness analysis
Cost-utility analysis
Cost-benefit analysis

+ Cost Analysis 8

unit cost analysis = $ per unit of output

n Evaluates costs but not value of output.

n Used to assess budgetary requirements.

n Provides breakdown of costs.

But,

It doesnt consider quality and effectiveness of interventions.


Need more sophisticated techniques . . .

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Cost-Effectiveness Analysis

n Assesses value of output (in non-monetary terms).

n Numerator = cost (and cost savings).

n Denominator = cases averted.

n CE ratio= costs per case averted.

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CEA Requires Comparison


n CEA is a relative term that compares interventions with
similar goals.

n An intervention cant be deemed cost-effective on its own.

+ Easy to understand.

+ Avoids valuing life saved.

+ Provides policy makers with an idea of which priority to


pursue.

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Cost-Utility Analysis

n Numerator = cost.

n Denominator = Quality Adjusted Life Years (QALYs) or


Disability Adjusted Life Years (DALYs).

n Pros and Cons:


+ Outcome combines morbidity and mortality.
- Hard to translate for policy makers and the public.
- Value of certain services may not be captured.
- Does not reflect the judgment of society.

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Cost-Benefit Analysis

n Monetary value on both cost and output.

n Difference vs. ratio


n Dollars spent on an intervention minus dollars saved in benefits.

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CBA Approaches

n Cost of illness (COI)


n Values the benefit of preventing HIV by the change in cost of
health care for HIV.

n Willingness to pay (WTP)


n Values patients perceived benefit of the intervention.

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CBA: advantages and disadvantages

+ No comparison intervention needed, compare different


objectives

- Assigns $ value to persons health

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When is Economic Evaluation


+ Necessary?
Cost Effectiveness Analysis
Kapan perlu dilakukan CEA atau CUA?
Intervensi A: Intervention A:
Lebih mahal Less Costly

Study Intervention A
Intervention A: necessary Optimal Strategy:
More Effective Study not
necessary

Intervention B is
Intervention A: Optimal Study
Less Effective Choice: Study necessary
not necessary

+ Health Related Quality of Life (QoL)


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Health: Health is a state of complete physical, mental, and


social well-being, and not merely the absence of disease or
infirmity."

World Health Organization, 1948

HRQoL: A persons or a groups subjective assessment of


the impact of their health on their functioning and well-being.

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Pengukuran HRQoL

Advantage Disadvantage

Health Individual Result cannot


Profile Outcomes be aggregated
(SF-36) Score in 1 number

Health Index Single score General for all


(QWB, HUI, (scale 1 to 0) dimensions
EQ-5D) allows easier
integration

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+ Quality Adjusted Life Years (QALYs)


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nQALY takes into consideration the length of


life and adjusts for quality using a utility
value

nOne year of perfect health is 1 QALY

nTwo years of health with a quality of life


adjustment of 0.5 is also 1 QALY

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+ Cost Utility Analysis


1.0 = Perfect Health

QALY =
0.75 Additional life years gained x Utility

n A
patient survives 20 yrs after leg
0.5
amputation

n The utility value for that state is 0.7


0.25
n 20years x 0.7 = 14 QALYs

0.0 = Death

- = Worse than death

+ Quality Adjusted Life Years (QALYs) 20

2. Dengan intervensi
Perfect health = 1.0
1. Tanpa intervensi
Health-related
quality of life
(Utility weights) QA
LY
s ga
ine
d

Duration
Death = 0.0 (Years of life)
Y1 Y2
Death 1 Death 2

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+ Cost Utility Analysis


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n What is cost effective?

n Batasan Cost effective vs. NICE (Inggris):

20.000 poundsterling per year per QALY gain

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Pengukuran Evaluasi Ekonomi

Cost analysis
$s per output

Cost-effectiveness analysis (CEA)


CEA = (C1 S1) / E
n $s per health benefit

Cost-utility analysis (CUA)


n $s per QALY or DALY
CUA = (C1 S1) /U

Cost-benefit analysis (CBA)


n Outcomes translated into
CBA = (W +S1+S2+S3+S4) / (C1+C2+C3+C4)
financial values NSBi =t=1n bi(t) ci(t)
(1+r)t-1

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Kasus
n Misalkan suatu program kesehatan mempunyai komponen
cost dan konsekuensi seperti berikut:

Cost Konsekuensi
C1 biaya pelayanan kesehatan Perbaikan kesehatan
$1.000.000 U 10 QALYs
C2 biaya kesehatan di sektor lain W (dengan willingness to pay)
$50.000 $2.000.000
C3 biaya sumberdaya pasien dan S1 saving untuk pelayanan kesehatan
keluarga $5.000 $25.000
C4 Biaya kehilangan produktivitas S2 saving di sektor lain $20.000
$100.000
S3 saving biaya sumberdaya pasien/
keluarga $12.000
S4 saving produktivitas $100.000
Hitunglah: Cost Utility ratio, (untuk sumber daya pelayanan
kesehatan saja dan seluruh sumber daya), Benefit cost ratio

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Referensi

n Drummond et.al (2005). Methods for the Economic Evaluation


of Health Care Programmes, 3rd ed. New York: Oxford
University Press.

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Terima kasih

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