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