Cost-effectiveness of a Community-based Rehabilitation Programme in Nepal

Kelsey Vaughan, Aradhana Thapa

Abstract


Purpose: This study aimed to estimate the cost-effectiveness of a community-based rehabilitation (CBR) programme known as Inspire2Care (I2C), implemented in Nepal by Karuna Foundation Nepal. In the absence of any gold standard methodology to measure cost-effectiveness, the authors developed a new methodology to estimate the programme’s achievements and cost-effectiveness.

Methods: Financial records were reviewed to determine total expenditure during the period August 2011 - December 2013. Programme records which documented the physical, mental and social status of children and adults with a disability qualitatively before, during and after the intervention were used to determine a starting disability weight and improvement score, which was then converted into a change in disability weight. The disability weight and expected remaining lifespan of each person were used to estimate disability-adjusted life years (DALYs) averted by the intervention. The cost per DALYaverted was estimated by dividing the total programme expenditure by the sum of DALYs averted over that same period.

Results: I2C cost 204,823 Euros to implement over the period August 2011 - December 2013. In total, an estimated 1,065 DALYs were averted from the treatment and rehabilitation components. The cost per DALY averted was 192.34 Euros.

Conclusions and Implications: The methodology devised for the study was able to successfully estimate the cost-effectiveness of the I2C programme. Using WHO benchmarks, this programme can be considered highly cost-effective. Other organisations can assess the cost-effectiveness of their programmes by using the assessment improvement score and subsequent conversion to DALYs averted. However, while mental, physical and social gains have been captured, other benefits from I2C cannot be captured in the cost per DALY averted statistic. Further research is needed to develop methods for incorporating these harder-to-measure gains in cost-effectiveness studies with a single outcome measure like the DALY.

Keywords


Health economics; cost-utility; disability-adjusted life years; disability inclusion; community development; UNCRPD

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References


Alavi Y, Kuper H (2010). Evaluating the impact of rehabilitation in the lives of people with disabilities and their families in low and middle income countries: a review of tools. Bensheim, Germany: CBM.

Central Bureau of Statistics (2012). National Population and Housing Census 2011 (National Report). Kathmandu: National Planning Commission.

Croft A (2013). Promoting access to education for disabled children in low-income countries: Do we need to know how many disabled children there are? International Journal of Educational Development; 33(3): 233-243. http://dx.doi.org/10.1016/j.ijedudev.2012.08.005

Dawad S, Jobson G, Ganie S, Quinlan T (2007). Costing and benefits of comprehensive care offered by the Valley Trust. Available from: http://www.heard.org.za/downloads/costing-and-benefits-of-comprehensive-care-offered-by-valley-trust.pdf [Accessed on 31 July 2015]

Drummond MF (2005). Methods for the economic evaluation of healthcare programmes. Oxford: Oxford University Press.

Eboh W (2000). Need for more comprehensive evaluation reports of CBR programmes. Available from: http://www.dinf.ne.jp/doc/english/asia/resource/apdrj/z13jo0300/z13jo0314.html [Accessed on 12 March 2015]

Finkenflügel H, Cornielje H,Velema J (2008). The use of classification models in the evaluation of CBR programmes. Disability and rehabilitation; 30(5): 348-354. http://dx.doi.org/10.1080/09638280701257288 PMid:17852305

Groce N, Kett M, Lang R, Trani J (2011). Disability and poverty: The need for a more nuanced understanding of implications for development policy and practice. Third World Quarterly; 32(8): 1493-1513. http://dx.doi.org/10.1080/01436597.2011.604520

Hutton G, Schellenberg D, Tediosi F, Macete E, Kahigwa E, Sigauque B, Mas X, Trapero M, Tanner M, Trilla A, Alonso P, Menendez C (2009). Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania. Bulletin of the World Health Organisation; 87(2): 123-129. http://dx.doi.org/10.2471/BLT.08.051961 PMid:19274364 PMCid:PMC2636201

Iezzoni LI (2011). Eliminating health and healthcare disparities among the growing population of people with disabilities. Health Affairs; 30(10): 1947-1954. http://dx.doi.org/10.1377/hlthaff.2011.0613 PMid:21976339

Institute for Health Metrics and Evaluation (IHME) (2012). Global burden of disease study 2010. Disability Weights. Available from: http://ghdx.healthdata.org/record/global-burden-disease-study-2010-gbd-2010-disability-weights [Accessed on 17 December 2014]

Jamison DT, Breman JG, Measham AR, et al (2006). Cost-effective strategies for the excess burden of disease in developing countries. Priorities in Health. Washington, DC: World Bank. Available from: http://www.ncbi.nlm.nih.gov/books/NBK10258/ [Accessed on 1 February 2016] http://dx.doi.org/10.1596/978-0-8213-6260-0; http://dx.doi.org/10.1596/978-0-8213-6260-0/Chpt-4

Karuna Foundation Nepal (2014a). Inspire2Care. Available from: http://www.karunafoundation.nl/projecten/inspiretocare_uk.html [Accessed on 10 December 2014]

Karuna Foundation Nepal (2014b). From pilot towards impact: First phase in Nepal (2007 - 2013). Karuna Foundation Nepal, Kathmandu, Nepal.

Khasnabis C, Heinicke MK, Achu K et al (2010). Towards community-based inclusive development. Geneva: WHO Press.

Leonardi M, Ustun TB (2002). The global burden of epilepsy. Epilepsia; 43(s6): 21-25. http://dx.doi.org/10.1046/j.1528-1157.43.s.6.11.x

Lukersmith S, Hartley S, Kuipers P, Madden R, Llewellyn G, Dune T (2013). Community-based rehabilitation (CBR) monitoring and evaluation methods and tools: a literature review. Disability and rehabilitation; 35(23): 1941-1953. http://dx.doi.org/10.3109/09638288.2013.770078

Mathers C, Fat DM, Boerma JT (2008). The global burden of disease: 2004 update. World Health Organisation. Available from: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf [Accessed on 10 December 2014] http://dx.doi.org/10.1016/b978-012373960-5.00335-x

Ministry of Health and Population & Government of Nepal (2010). Nepal Health Sector Programme-II (NHSP -II) 2010 – 2015. Kathmandu: Ministry of Health and Population, Nepal.

Møller V, Huschka D (2008). Quality of life and the millennium challenge.Heidelberg: Springer Netherlands. http://dx.doi.org/10.1007/978-1-4020-8569-7_1

Murray CJL, Ezzati M, Flaxman AD, Lim S, Lozano R, Michaud C, Naghavi M, Salomon JA, Shibuya K, Vos T, Wikler D, Lopez AD (2013). GBD 2010: design, definitions, and metrics.The Lancet; 380(9859): 2063-2066. http://dx.doi.org/10.1016/S0140-6736(12)61899-6

Parks R (2014). The rise, critique and persistence of the DALY in global health. Available from: http://www.ghjournal.org/the-rise-critique-and-persistence-of-the-daly-in-global-health/ [Accessed on 10 December 2014]

Robertson J, Emerson E, Hatton C, Yasamy MT (2012). Efficacy of community‐based rehabilitation for children with or at significant risk of intellectual disabilities in low‐and middle‐income countries: a review. Journal of Applied Research in Intellectual Disabilities; 25(2): 143-154. http://dx.doi.org/10.1111/j.1468-3148.2011.00679.x

Salomon JA, Haagsma JA, Davis A, de Noordhout CM, Polinder S, Havelaar AH, Cassini A, Devleesschauwer B, Kretzschmar M, Speybroeck N, Murray CJL, Vos T (2015). Disability weights for the global burden of disease 2013 study. The Lancet Global Health; 3(11): e723. http://dx.doi.org/10.1016/S2214-109X(15)00069-8

Schildbach E, Mey PD, Dhungana BM, Lamichhane J (2012). Persons with disabilities and their access to healthcare services in Nepal. Kathmandu: The Deutsche Gesellschaftfür Internationale Zusammenarbeit (GIZ).

Social Policy and Poverty Research Group (SPPR) (2012). Including people affected by leprosy in mainstream community-based rehabilitation programmes: efficacy and cost-effectiveness. SPPR Bulletin; 1(4). Available from: http://www.lift-fund.org/sites/lift-fund.org/files/publication/Vol%201,No.4%20May%202012%20Bulletin_0.pdf [Accessed on 1 February 2016]

Struijk EA, May AM, Beulens JWJ, de Wit GA, Boer JMA, Onland-Moret NC, Van der Schouw YT, Bueno-de-Mesquita HB, Hoekstra J, Peeters PHM (2013). Development of methodology for disability-adjusted life years (DALYs) calculation based on real-life data. PLOS ONE; 8(9). http://dx.doi.org/10.1371/journal.pone.0074294

Temple-Bird C, Kawohl W, Lenel A, Kaur M (2005). How to plan and budget for your healthcare technology. United Kingdom: Teaching-aids At Low Cost.

Van Veen NH, McNamee P, Richardus JH, Smith WC (2009). Cost-effectiveness of interventions to prevent disability in leprosy: a systematic review. PLOS ONE; 4(2): e4548. http://dx.doi.org/10.1371/journal.pone.0004548

Voigt K, King NB (2014). Disability weights in the global burden of disease 2010 study: two steps forward, one step back? Bulletin of the World Health Organisation; 92(3): 226-228. http://dx.doi.org/10.2471/BLT.13.126227

World Bank (2013). GDP per capita. Available from: http://data.worldbank.org/indicator/NY.GDP.PCAP.CD [Accessed on 17 December 2014]

World Bank (2014). World development indicators database. Available from: data.worldbank.org/indicator/SP.DYN.CBRT.IN [Accessed on 17 December 2014].

World Health Organisation (2001). International classification of functioning, disability and health. Geneva: World Health Organisation.

World Health Organisation (2008). Global burden of disease 2004 update: disability weights for diseases and conditions. Available from: http://www.who.int/healthinfo/global_burden_disease/GBD2004_DisabilityWeights.pdf [Accessed on 15 December 2014]

World Health Organisation (2011). WHODAS 2.0. Available from: http://www.who.int/classifications/icf/whodasii/en/ [Accessed on 17 December 2014].

World Health Organisation (2014). Cost effectiveness and strategic planning (WHO-CHOICE): cost-effectiveness thresholds. Available from: http://www.who.int/choice/costs/CER_levels/en/ [Accessed on 1 February 2016]

World Health Organisation (no date). Disability weights, discounting and age weighting of DALYs. Available from: http://www.who.int/healthinfo/global_burden_disease/daly_disability_weight/en/ [Accessed on 17 December 2014]




DOI: http://dx.doi.org/10.5463/dcid.v26i4.457

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