Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Cost Effectiveness and Resource Allocation
Published in: Cost Effectiveness and Resource Allocation 1/2008

Open Access 01-12-2008 | Research

Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease

Authors: Kristian Schultz Hansen, Glyn Chapman

Published in: Cost Effectiveness and Resource Allocation | Issue 1/2008

Login to get access

Abstract

Background

This study aimed at providing information for priority setting in the health care sector of Zimbabwe as well as assessing the efficiency of resource use. A general approach proposed by the World Bank involving the estimation of the burden of disease measured in Disability-Adjusted Life Years (DALYs) and calculation of cost-effectiveness ratios for a large number of health interventions was followed.

Methods

Costs per DALY for a total of 65 health interventions were estimated. Costing data were collected through visits to health centres, hospitals and vertical programmes where a combination of step-down and micro-costing was applied. Effectiveness of health interventions was estimated based on published information on the efficacy adjusted for factors such as coverage and compliance.

Results

Very cost-effective interventions were available for the major health problems. Using estimates of the burden of disease, the present paper developed packages of health interventions using the estimated cost-effectiveness ratios. These packages could avert a quarter of the burden of disease at total costs corresponding to one tenth of the public health budget in the financial year 1997/98. In general, the analyses suggested that there was substantial potential for improving the efficiency of resource use in the public health care sector.

Discussion

The proposed World Bank approach applied to Zimbabwe was extremely data demanding and required extensive data collection in the field and substantial human resources. The most important limitation of the study was the scarcity of evidence on effectiveness of health interventions so that a range of important health interventions could not be included in the cost-effectiveness analysis. This and other limitations could in principle be overcome if more research resources were available.

Conclusion

The present study showed that it was feasible to conduct cost-effectiveness analyses for a large number of health interventions in a developing country like Zimbabwe using a consistent methodology.
Literature
1.
Maynard A: Developing the health care market. Econ J 1991, 101: 1277–1286. 10.2307/2234443CrossRef
2.
Birkett DJ, Mitchell AS, McManus P: A cost-effectiveness approach to drug pricing in Australia. Health Affairs 2001, 20: 104–114. 10.1377/hlthaff.20.3.104PubMedCrossRef
3.
4.
Talmor D, Shapiro N, Greenberg D, Stone PW, Neumann PJ: When is critical care medicine cost-effective? A systematic review of the cost-effectiveness literature. Crit Care Med 2006, 34: 2738–2747. 10.1097/01.CCM.0000241159.18620.ABPubMedCrossRef
5.
Jamison DT, Mosley WH, Measham AR, Bobadilla JL, Eds: Disease control priorities in developing countries. New York: Oxford University Press; 1993.
6.
Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, Eds: Disease control priorities in developing countries. 2nd edition. New York: Oxford University Press; 2006.
7.
Laxminarayan R, Chow J, Shahid-Salles SA: Intervention cost-effectiveness: overview of main messages. In Disease control priorities in developing countries. 2nd edition. Edited by: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P. New York: Oxford University Press; 2006:35–86.
8.
Hutubessy R, Chisholm D, Tan Torres-Edejer T, WHO-CHOICE: Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc 2003, 1: 8. 10.1186/1478-7547-1-8PubMedCentralPubMedCrossRef
9.
10.
Johns B, Baltussen R, Hutubessy R: Programme costs in the economic evaluation of health interventions. Cost Eff Resour Alloc 2003, 1: 1. 10.1186/1478-7547-1-1PubMedCentralPubMedCrossRef
11.
Jha P, Bangoura O, Ranson K: The cost-effectiveness of forty health interventions in Guinea. Health Policy Plan 1998, 13: 249–262. 10.1093/heapol/13.3.249PubMedCrossRef
12.
Musgrove P, Fox-Rushby J: Cost-effectiveness analysis for priority setting. In Disease control priorities in developing countries. 2nd edition. Edited by: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P. New York: Oxford University Press; 2006:271–285.
13.
Evans DB, Tan-Torres Edejer T, Adam T, Lim SS: Achieving the millennium development goals for health: methods to assess the costs and health effects of interventions for improving health in developing countries. BMJ 2005, 331: 1137–1140. 10.1136/bmj.331.7525.1137PubMedCentralPubMedCrossRef
14.
Williams A: Calculating the global burden of disease: time for a strategic reappraisal? Health Econ 1999, 8: 1–8. 10.1002/(SICI)1099-1050(199902)8:1<1::AID-HEC399>3.0.CO;2-BPubMedCrossRef
15.
Kumaranayake L, Walker D: Cost-effectiveness analysis and priority-setting: global approach without meaning? In Health policy in a globalising world. Edited by: Lee K, Buse K, Fustukian S. Cambridge: Cambridge University Press; 2002:140–156.
16.
World Bank: World Development Report 1993: investing in health. New York: Oxford University Press; 1993.CrossRef
17.
Bobadilla JL, Cowley P, Musgrove P, Saxenian H: Design, content and financing of an essential national package of health services. In Global comparative assessments in the health sector: disease burden, expenditures and intervention packages. Edited by: Murray CJL, Lopez AD. Geneva: World Health Organization; 1994:171–180.
18.
Chapman G, Hansen KS, Jelsma J, Ndhlovu C, Piotti B, Byskov J, Vos T: The Burden of Disease in Zimbabwe in 1997 as measured by Disability-Adjusted Life Years lost. Trop Med Int Health 2006, 11: 667–678. 10.1111/j.1365-3156.2006.01601.xCrossRef
19.
Ministry of Health and Child Welfare: Zimbabwe national health profile 1998. Harare: Government of Zimbabwe, National Health Information and Surveillance Unit; 1999.
20.
United Nations Development Programme: Human Development Report 1998 Zimbabwe. Harare: United Nations Development Programme, Zimbabwe, Poverty Reduction Forum, Government of Zimbabwe, Institute of Development Studies, University of Zimbabwe; 1998.
21.
Economist Intelligence Unit: Country profile Zimbabwe 2008. London: Economist Intelligence Unit; 2008.
22.
World Bank: Zimbabwe. Financing health services. Washington, D.C.: The World Bank; 1992.
23.
Ministry of Health and Child Welfare: EDLIZ – fourth essential drugs list and standard treatment guidelines for Zimbabwe. Harare: Government of Zimbabwe, Directorate of Pharmacy Services; 2000.
24.
Drummond MF, Sculpher MJ, Torrance GW, O'Brien B, Stoddart GL, Eds: Methods for the economic evaluation of health care programmes. 3rd edition. Oxford: Oxford University Press; 2005.
25.
Walker D, Kumaranayake L: Allowing for differential timing in cost analyses: discounting and annualization. Health Policy Plan 2002, 17: 112–118. 10.1093/heapol/17.1.112PubMedCrossRef
26.
Conteh L, Walker D: Cost and unit cost calculations using step-down accounting. Health Policy Plan 2004, 19: 127–135. 10.1093/heapol/czh015PubMedCrossRef
27.
Luce BR, Manning WG, Siegel JE, Lipscomp J: Estimating costs in cost-effectiveness analysis. In Cost-effectiveness in health and medicine. Edited by: Gold MR, Siegel JE, Russell LB, Weinstein MC. New York: Oxford University Press; 1996:176–213.
28.
Central Statistical Office: Census 1992. Provincial profile, Midlands. Harare: Government of Zimbabwe; 1994.
29.
Central Statistical Office: Census 1992. Provincial profile, Manicaland. Harare: Government of Zimbabwe; 1994.
30.
Central Statistical Office: Zimbabwe 1997 inter-censal demographic survey report. Harare: Government of Zimbabwe; 1998.
31.
Central Statistical Office [Zimbabwe] and Macro International Inc.: Zimbabwe Demographic and Health Survey 1999. Calverton: Macro International Inc.; 2000.
32.
Murray CJL: Quantifying the burden of disease: the technical basis for disability-adjusted life years. In Global comparative assessments in the health sector: disease burden, expenditures and intervention packages. Edited by: Murray CJL, Lopez AD. Geneva: World Health Organization; 1994:3–19.
33.
Murray CJL: Rethinking DALYs. In The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Edited by: Murray CJL, Lopez AD. Boston: Harvard University Press; 1996:1–98.
34.
Murray CJL, Acharya AK: Understanding DALYs. J Health Econ 1997, 16: 703–730. 10.1016/S0167-6296(97)00004-0PubMedCrossRef
35.
Murray CJL, Lopez AD, Eds: The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Boston: Harvard University Press; 1996.
36.
Coale A, Guo G: Revised regional model life tables at very low levels of mortality. Population Index 1989, 55: 613–643. 10.2307/3644567PubMedCrossRef
37.
Fox-Rushby JA, Hanson K: Calculating and presenting disability adjusted life years (DALYs) in cost-effectiveness analysis. Health Policy Plan 2001, 16: 326–331. 10.1093/heapol/16.3.326PubMedCrossRef
38.
Vlassoff C, Tanner M: The relevance of rapid assessments to health research and interventions. Health Policy Plan 1992, 7: 1–9. 10.1093/heapol/7.1.1CrossRef
39.
Mabey D, Fraser-Hunt N: Antibiotics for trachoma. The Cochrane Library. Oxford: Update Software; 2003.
40.
Guyatt HL, Kinnear J, Burini M, Snow RW: A comparative cost analysis of insecticide-treated nets and indoor residual spraying in Highland Kenya. Health Policy Plan 2002, 17: 144–153. 10.1093/heapol/17.2.144PubMedCrossRef
41.
Varley RCG: Child survival and environmental health interventions: a cost-effectiveness analysis. Applied Study no. 4. Washington DC: Environmental Health Project; 1996.
42.
Murphy H, Stanton B, Galbraith J: Prevention: environmental health interventions to sustain child health survival. Applied Study no. 3. Washington DC: Environmental Health Project; 1997.
43.
Martines J, Phillips M, Feachem RGA: Diarrhoeal diseases. In Disease control priorities in developing countries. Edited by: Jamison DT, Mosley WH, Measham AR, Bobadilla JL. New York: Oxford University Press; 1993:91–116.
44.
Pinstrup-Andersen P, Burger S, Habicht JP, Peterson K: Protein-energy malnutrition. In Disease control priorities in developing countries. Edited by: Jamison DT, Mosley WH, Measham AR, Bobadilla JL. New York: Oxford University Press; 1993:391–420.
45.
Foster SO, McFarland DA, John AM: Measles. In Disease control priorities in developing countries. Edited by: Jamison DT, Mosley WH, Measham AR, Bobadilla JL. New York: Oxford University Press; 1993:161–187.
46.
Jamison DT, Torres AM, Chen LC, Melnick JL: Poliomyelitis. In Disease control priorities in developing countries. Edited by: Jamison DT, Mosley WH, Measham AR, Bobadilla JL. New York: Oxford University Press; 1993:117–129.
47.
Gilson L, Mkanje R, Grosskurth H, Mosha F, Picard J, Gavyole A, Todd J, Mayaud P, Swai R, Fransen L, Mabey D, Mills A, Hayes R: Cost-effectiveness of improved treatment services for sexually transmitted diseases in preventing HIV-1 infection in Mwanza region, Tanzania. Lancet 1997, 350: 1805–1809. 10.1016/S0140-6736(97)08222-6PubMedCrossRef
48.
Mayaud P, Mosha F, Todd J, Balira R, Mgara J, West B, Rusizoka M, Mwijarubi E, Gabone R, Gavyole A, Grosskurth H, Hayes R, Mabey D: Improved treatment services significantly reduce the prevalence of sexually transmitted diseases in rural Tanzania: results of a randomized controlled trial. AIDS 1997, 11: 1873–1880. 10.1097/00002030-199715000-00013PubMedCrossRef
49.
Johannesson M, Weinstein MC: On the decision rules of cost-effectiveness analysis. J Health Econ 1993, 12: 459–467. 10.1016/0167-6296(93)90005-YPubMedCrossRef
50.
Weinstein MC, Zeckhauser R: Critical ratios and efficient allocation. J Public Econ 1973, 2: 147–157. 10.1016/0047-2727(73)90002-9CrossRef
51.
Birch S, Gafni A: Cost effectiveness/utility analyses: do current decision rules lead us where we want to be? J Health Econ 1992, 11: 279–296. 10.1016/0167-6296(92)90004-KPubMedCrossRef
52.
Cairns J: Discounting in economic evaluation. In Economic evaluation in health care. Edited by: Drummond M, McGuire A. Oxford: Oxford University Press; 2001:236–255.
53.
Robberstad B: Estimation of private and social time preferences for health in northern Tanzania. Soc Sci Med 2005, 61: 1597–1607. 10.1016/j.socscimed.2005.03.013PubMedCrossRef
54.
Barnum H, Kutzin J: Public hospitals in developing countries: resource use, cost, financing. Baltimore: The Johns Hopkins University Press; 1993.
55.
Hansen K, Ghapman G, Chitsike I, Kasilo O, Mwaluko G: The costs of HIV/AIDS care at government hospitals in Zimbabwe. Health Policy Plan 2000, 15: 432–440. 10.1093/heapol/15.4.432PubMedCrossRef
56.
Brenzel L, Wolfson LJ, Fox-Rushby J, Miller M, Halsey NA: Vaccine-preventable diseases. In Disease control priorities in developing countries. 2nd edition. Edited by: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P. New York: Oxford University Press; 2006:389–411.
57.
Elbasha HE, Messonnier ML: Cost-effectiveness analysis and health care resource allocation: decision rules under variable returns to scale. Health Econ 2004, 13: 21–35. 10.1002/hec.793PubMedCrossRef
58.
Murray CJL, Evans DB, Acharya A, Baltussen RMPM: Development of WHO guidelines on generalized cost-effectiveness analysis. Health Econ 2000, 9: 235–251. 10.1002/(SICI)1099-1050(200004)9:3<235::AID-HEC502>3.0.CO;2-OPubMedCrossRef
59.
Murray CJL, Kreuser J, Whang W: Cost-effectiveness analysis and policy choices: investing in health systems. In Global comparative assessments in the health sector: disease burden, expenditures and intervention packages. Edited by: Murray CJL, Lopez AD. Geneva: World Health Organization; 1994:181–192.
60.
Stinnett AA, Paltiel DA: Mathematical programming for the efficient allocation of health care resources. J Health Econ 1996, 15: 641–653. 10.1016/S0167-6296(96)00493-6PubMedCrossRef
61.
Haws RA, Thomas AL, Bhutta ZA, Darmstadt GL: Impact of packaged interventions on neonatal health: a review of the evidence. Health Policy Plan 2007, 22: 193–215. 10.1093/heapol/czm009PubMedCrossRef
62.
Task Force on Health Systems Research: Informed choices for attaining the Millennium Development Goals: towards an international cooperative agenda for health-systems research. The Lancet 2004, 364: 997–1003. 10.1016/S0140-6736(04)17026-8CrossRef
63.
Vundule C, Mharakurwa S: Knowledge, practices, and perceptions about malaria in rural communities of Zimbabwe – relevance for malaria control. Bull World Health Organ 1996, 74: 55–60.PubMedCentralPubMed
64.
Wright J, Walley J, Philip A, Pushpananthan S, Dlamini E, Newell J, Dlamini S: Direct observation of treatment for tuberculosis: a randomized controlled trial of community health workers versus family members. Trop Med Int Health 2004, 9: 559–565. 10.1111/j.1365-3156.2004.01230.xPubMedCrossRef
65.
Pearson CR, Micek MA, Simoni JM, Hoff PD, Matediana E, Martin DP, Gloyd SS: Randomized controlled trial of peer-delivered, modified directly observed therapy for HAART in Mozambique. J Acquir Immune Defic Syndr 2007, 46: 238–244. 10.1097/QAI.0b013e318153f7baPubMedCentralPubMedCrossRef
66.
Hongoro C, Lorenzoni L: Cost analysis for rehabilitation services in Zimbabwe. Harare: Government of Zimbabwe, Blair Research Institute, Ministry of Health and Child Welfare; 1994.
67.
Hongoro C: Purchaser/provider relationships in health care: the government and mission health care providers in Zimbabwe. Harare: Government of Zimbabwe, Blair Research Institute, Ministry of Health and Child Welfare; 1995.
68.
Bijlmakers L, Chihanga S: District health service costs, resource adequacy and efficiency: a comparison of three districts. Harare: Government of Zimbabwe, Ministry of Health and Child Welfare and UNICEF Zimbabwe; 1995.
69.
Canning D: The economics of HIV/AIDS in low-income countries: the case for prevention. J Econ Perspectives 2006, 20: 121–142. 10.1257/jep.20.3.121CrossRef
70.
Kapiriri L, Martin DK: Bedside rationing by health practitioners: a case study in a Ugandan hospital. Med Decis Making 2007, 27: 44–52. 10.1177/0272989X06297397PubMedCrossRef
71.
Baltussen R, Stolk E, Chisholm D, Aikins M: Towards a multi-criteria approach for priority setting: an application to Ghana. Health Econ 2006, 15: 689–696. 10.1002/hec.1092PubMedCrossRef
72.
Makundi E, Kapiriri L, Norheim OF: Combining evidence and values in priority setting: testing the balance sheet method in a low-income country. BMC Health Serv Res 2007, 7: 152. 10.1186/1472-6963-7-152PubMedCentralPubMedCrossRef
73.
Kapiriri L, Martin DK: A strategy to improve priority setting in developing countries. Health Care Anal 2007, 15: 159–167. 10.1007/s10728-006-0037-1PubMedCrossRef
Metadata
Title
Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease
Authors
Kristian Schultz Hansen
Glyn Chapman
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Cost Effectiveness and Resource Allocation / Issue 1/2008
Electronic ISSN: 1478-7547
DOI
https://doi.org/10.1186/1478-7547-6-14

Other articles of this Issue 1/2008

Cost Effectiveness and Resource Allocation 1/2008 Go to the issue

Research

Integrating tuberculosis and HIV services for people living with HIV: Costs of the Zambian ProTEST Initiative

Research

Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: A cost-effectiveness analysis

Research

People's willingness to pay for health insurance in rural Vietnam

Research

Decision maker views on priority setting in the Vancouver Island Health Authority

Research

The costs of traumatic brain injury due to motorcycle accidents in Hanoi, Vietnam

Research

Non-pharmaceutical prevention of hip fractures – a cost-effectiveness analysis of a community-based elderly safety promotion program in Sweden