the disease control priorities project: accomplishments and future challenges dean t. jamison...

The Disease Control Priorities Project:

Accomplishments and Future Challenges

Dean T. Jamison

University of Washington

Presentation at

Priorities 2010

Boston, MA

24 April 2010

• The Disease Control Priorities Project (DCPP)

• Future Challenges

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Outline

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DCPP by the Numbers

2 = Number of Books

4 = Number of years

13 = Number of Editors

78 = Number of Chapters

350 = Number of Authors

500 = Number of additional contributors

6 million = Number of dollars

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Don’t buy this book!

www.dcp2.org

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Future Challenges

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Cost-effectiveness Analysis and Health System Planning: Problems with Where we are Today

• Insufficient attention to the instruments of policy

• Insufficient attention to the platforms that carry interventions

• Insufficient attention to non-incremental interventions

(focus is on ICER)

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Cost-effectiveness Analysis and Health System Planning: Problems with Where we are Today

• Insufficient attention to urgency of intervention

• Failure to consider financial risk protection

• Limited consideration of health system capacity constraints

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Instruments of Policy

• IEC

• Taxes and subsidies

• Regulation and legislation

• Direct finance (number and location of providers)

• R&D

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Intervention Delivery Platforms

• Primary Care

• Hospitals

• Public Health

• Inter-sectoral

• Support

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District Hospital

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Medical and pediatric service TB treatment; AMI and stroke treatment, IMCI for severe cases, complicate malaria

Surgical, obstetric and trauma service Delivery, trauma, other ‘essential” surgical services

Specialized Hospitals

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Multi-specialty referral hospital As for district hospital but also a broad range of more complex cases

Single specialty hospitals Psychiatric, TB, cancer, obstetric fistula repair

Support Platforms

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Platform Examples

1. Disease, risk factor and demographic NHANES; DHS; Censuses; Sentinal surveillance surveillance systems

2. Education and training of health Medical, dental and nursing schools;

professionals in-service training

3. Monitoring and evaluation of Effective coverage surveysInterventions, expenditures and (commencing); appropriate

household consequences of ill-health surveys

4. R&D Basic scientific to operational research; product

development and evaluation

5.Insurance systems Mandatory health insurance in almost all countries of OECD

Analyzing the burden of a health problem to identify control and research needs

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Temporal Character of Interventions

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Temporal Character Examples

1. Urgent

2. Moderately time sensitive

3. Not time sensitive

4. Ongoing

• C-Section for obstructed labor• Malaria treatment• AMI treatment

• Immunization• TB Treatment

• Elective surgery (cataract replacement; obstetric fibula repair)

• Dietary and other behavioral change• Medical management of AIDS,

vascular risk, diabetes, psychiatric disorders

The Focus of CEA

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Note: The shaded box represents the domain of traditionalcost-effectiveness analysis.

Costs

Resources ($)

Health(DALYs)

Outcomes

Financial protection

Health system capacity

The Focus of CEA, II

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Note: The shaded box represents the domain of traditionalcost-effectiveness analysis.

Locus of Intervention

Consequenceof intervention

Health

Non-Health

Outside Health SystemInside Health System

• Water supply• Food transfers• Sanitation• Basic education• Carbon tax

• ‘Nuisance’ health problems (eg. seasonal flu)

• Cosmetic procedures• Enhanced functioning (mental, physical, sexual)

• Contraception

General GBA