Public Health Economics – Methods and Tools
Centers for Disease Control and Prevention –CDC
CDC employs more than 60 doctoral level health economists, more than any federal agency. CDC health economists published over 100 peer-reviewed articles in 2010 alone, yet many public health professionals are not familiar with their work.
Health economists use the following general methods:
•Cost analysis refers to the systematic collection, categorization, and analysis of intervention/program costs, side effects costs (or externalities), and illness costs. CDC economists have explored the costs of different types of cancers, hospital-acquired infections, communicable diseases, and even the costs of an outbreak investigation for local health departments.
•Economic evaluations provide a systematic approach for assessing and comparing two or more interventions or programs in terms of their respective costs or benefits and includes cost-effectiveness, cost-benefit, and cost-utility analyses. CDC economists recently performed economic evaluations on screening options for diabetes, diagnostic options for HIV and TB, vaccine strategies, TB treatment regimes, and injury prevention programs.
•Decision and transmission modeling includes developing and testing various models such as simple regression models, Markov decision choice models, agent-based models, simulations, and theoretical mathematical models. CDC economists have performed modeling on vaccine strategies, HIV diagnosis and treatment alternatives, and state public health resource allocation options.
•Regulatory analysis is a tool regulatory agencies use to anticipate and evaluate the likely consequences of rules. The impact of regulations on costs and/or behaviors becomes increasingly more important as health protection is further emphasized in public health. Highlights from CDC economists' work in this area include an analysis of the removal of HIV infection from the definition of communicable diseases of public health significance and the impact of regulations requiring pre-travel medical consultation for international travelers.
Members of the public health community are encouraged to make use of the following tools for improving practices around the evaluation of health costs and burden, and health program effectiveness and efficiency. These tools have been created by CDC and its partners. CDC health economists are continually working on new tools, which will be added to this collection.
Chronic Disease Cost Calculator
The Chronic Disease Cost Calculator was designed to help states estimate the burden and financial impact of chronic diseases among their Medicaid beneficiaries. The downloadable tool supports states in estimating state Medicaid expenditures for six chronic diseases (congestive heart failure, heart disease, stroke, hypertension, cancer, and diabetes) and generating estimates of the costs to Medicaid for selected chronic diseases using customized inputs, such as prevalence rates and treatment costs.
CommunityFlu 1.0 was designed to simulate the spread of influenza through a model community and assess the impact of a variety of potential interventions (e.g., vaccinations, school closings, wearing of face masks, patient and household isolation/self quarantine). The tool also provides estimates for the number of cases, hospitalizations, and deaths that may be seen among different age groups found in a representative community. CommunityFlu 1.0 allows a user to estimate the economic impact, in terms of days of work lost, of an influenza epidemic/pandemic in a community, thus calculating the savings and costs associated with one or more interventions.
FluAid 2.0 was designed to assist state- and local-level planners in preparing for the next influenza pandemic by providing estimates of the potential impact specific to their locality. This tool provides a range of impact estimates in terms of deaths, hospitalizations, and outpatients visits due to pandemic influenza. Due to the heightened awareness during the 2009 H1N1 Response, FluAid 2.0 was adapted so states and public health planners could estimate the state-level impact of the 2009 H1N1 Influenza A using spring 2009 H1N1 collected data.
FluLabSurge 1.0 was designed to assist laboratory directors with estimating the demand for specimen testing during an influenza pandemic and public health planners in developing pandemic response plans. This tool generates estimates for the daily number of specimens that may be delivered to a laboratory for testing and evaluates the testing capacity of a specific laboratory (e.g., how many samples can be tested per day or work shift) per pandemic transitional day found in each of the pandemic stages. FluLabSurge 1.0 produces a one-page plan showing how capacity will be used to meet user-defined testing goals (e.g., surveillance, strain identification, clinical diagnostics).
FluSurge 2.0 was designed to provide hospital administrators and public health officials with estimates of the surge in demand for hospital-based services during an influenza pandemic. This tool estimates the number of hospitalizations and deaths of an influenza pandemic (whose length and virulence are determined by the user) and the number of persons hospitalized, requiring ICU care, and requiring ventilator support during a pandemic with existing hospital capacity. FluSurge 2.0 was adapted to provide hospital administrators and public health officials with estimates of the surge demand for hospital-based services during the 2009 H1N1 Influenza event.
FluWorkLoss 1.0 was designed to estimate the potential number of days lost from work due to an influenza pandemic. This tool provides a range of estimates for the total number of workdays lost, as well as graphic illustrations of the workdays lost by week and percentage of total workdays lost to influenza-related illnesses. Due to the heightened awareness during the 2009 H1N1 response, it was adapted to estimate the total number of workdays that could be lost as a specific result of the 2009 H1N1 Influenza A event.
HIV Economic Model: HIVEcon
HIV Economic Model (HIVEcon) was developed to help assess all costs and benefits of the proposed rule change to remove HIV infection from
Maxi-Vac 1.0 and Maxi-Vac Alternative
Maxi-Vac 1.0 and Maxi-Vac Alternative were designed to be used by state and local public health officials to assist with planning large-scale smallpox vaccination clinics with maximum patient flow-through. Users can select the number and type of professional resources available to operate a clinic (e.g., physicians, nurses) and the software will allocate those staff among the pre-designated required activities, optimizing clinic operations.
MedCon:Pre-Event has been designed to estimate the baseline medical care requirements (i.e., the number of persons that would require medical care) of a displaced population following a disaster due to pre-existing medical conditions. MedCon:Pre-Event has not been designed for estimating the medical care requirements due to direct impact of the event (e.g., injuries and illness) or additional medical care requirements resulting from the aggravation of the existing medical condition. This tool will be useful for public health preparedness planners at local, state, and federal levels involved in addressing the large-scale medical care requirements resulting from man-made and natural disasters.
Obesity Cost Calculator
The Obesity Cost Calculator uses input data provided by human resources or benefits personnel to calculate an estimate of organization costs related to obesity and to compare the costs and benefits of user-defined interventions targeted at reducing obesity. More specifically, the Obesity Cost Calculator estimates the costs of obesity based on characteristics of the organization (including costs for medical expenditures and the dollar value of increased absenteeism resulting from obesity), and provides a module to assess expected savings of interventions to reduce obesity, potential reductions in medical costs and work loss resulting from interventions, and the number of years before a break-even period is reached. Each is estimated under several user-driven scenarios concerning the expected costs and savings resulting from the intervention.
SurvCost is a spreadsheet-based tool developed to aid public health officials in estimating the cost of Integrated Disease Surveillance and Response (IDSR) systems at national, region/province, district, and health facility. SurvCost estimates the costs of seven categories of resources: personnel, office operating items, transportation, laboratory materials and supplies, treatment and programmatic response items, media or public awareness campaigns, and capital items. The estimates of costs by category allow surveillance system managers to better understand the resources required to operate IDSR systems. SurvCost may also be of use to managers of other disease surveillance systems who wish to estimate their costs.
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