Finance-Return on Investment
Room: Thoroughbred 1
Wednesday, April 9, 2014, 2-3:15 pm
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AUDIO
KC14 Session 4A on Finance: Return on Investment by NCC for PHSSR
MODERATOR
Adam Atherly, Ph.D.
PRESENTERS
Kaja Abbas, Ph.D., M.P.H.
Economic Evaluation of Public Health Interventions: Outbreak Responses of Pertussis, Tuberculosis and Fungal Meningitis in New River Valley, Virginia
Co-Investigators: Narges Dorratoltaj, M.S., Jennifer Samuels, Karina Platt, M.P.H, Paige Bordwine, M.P.H, Margarat O'Dell, M.D., Thomas Kerkering, M.D., Kerry Redican, Ph.D., M.P.H, M.S.P.H.
Background: A pertussis outbreak occurred at New River Valley in 2011, with an incidence of 72 confirmed cases. A tuberculosis outbreak occurred in a correctional facility at New River Valley in 2011, with a single case and tuberculosis exposure to other inmates and staff at the facility. New River Valley was the epicenter of the multi-state fungal meningitis outbreak during 2012-2013. New River Health District responded to these outbreaks and they were controlled.
Research Objective: The objective of this study is to compare the relative costs and epidemiological benefits of multiple outbreak responses in New River Valley, Virginia.
Data Sets and Sources: Data collected by the New River Health District, Virginia Department of Health, of the outbreak responses to pertussis, tuberculosis and fungal meningitis between 2011-2013 are used in this study.
Study Design: Cost-effectiveness analysis was carried out on each of the three outbreaks of pertussis, tuberculosis and fungal meningitis in New River Valley, Virginia.
Analysis: We estimated the incremental cost-effectiveness ratios for pertussis, tuberculosis, and fungal meningitis outbreaks to be $7,468/DALY averted, -15,461/DALY averted and $415/DALY averted.
Principal Findings: Tuberculosis pre-screening is a cost-saving intervention in correctional facilities and should be readily adopted.
Conclusions: While the tuberculosis pre-screening program is cost-saving, fungal meningitis outbreak response was comparatively more cost-effective to the pertussis outbreak response.
Implications for Public Health Practice and Policy: Comparative evaluation of multiple public health interventions assists the health department in prioritization and optimal allocation of limited resources.
Margaret Knight, Ph.D., M.P.H., M.S., B.A.
The Effects of the Changes in Section 317 Rules for Administration of Federally Purchased Vaccines
Co-Investigators: Anne Kershenbaum, M.D., M.P.H., Paul Erwin, M.D., Dr.P.H., Martha Buchanan, M.D., Janet Ridley, M.S.N., B.S.
Background: This completed research project focuses on the financing of immunizations in the US. Annual allocations for purchasing vaccines fluctuate from year to year as Congress responds to changes in national needs for immunizations. The Affordable Care Act (ACA), which requires first dollar coverage of immunizations and other preventive care led to changes in funding policy in fiscal year 2012. In Tennessee, the response was a policy change that redefined the population who would receive immunizations at health departments.
Research Objective: The research objective of this project was to determine the effect, if any, of this change in funding policy.
Data Sets & Sources: The data, spanning October 2012 to October 2013 were collected from the Patient, Tracking, Billing, and Management Information System (PTBMIS) used by Knox County Health Department (KCHD) and the East Tennessee Region (ETR) of the Tennessee Department of Health.
Study Design: Monthly immunization counts were used to calculate median monthly immunizations at each site for two age groups: birth to five years and six years to eighteen years from both KCHD and ETR.
Methods/Analysis: The Mann-Whitney test was used to determine the significance of the difference in numbers of vaccines administered year to year, producing p-values for each age group and each vaccine at a level of significance for statistical tests set at p
Results: We found very little decrease in median monthly vaccines between the two fiscal years. Conclusions: The Tennessee Department of Health policy change in FY 2012 restricting vaccination of insured Tennesseans in response to the elimination of American Recovery and Reinvestment Act (ARRA) funding for the Vaccines for Children program.
Implications: Public health implications include a continued need for agility in responding to fluctuations in funding and continued monitoring of the effects of policy changes on access to preventive care as the PPACA effects unfold.
Paul Brown, Ph.D.
Economic Burden of Chronic Diseases in California
Co-Investigators: Mariaelena Gonzalez, Ph.D., Ritem Sandhu, M.S. (Presenting)
Background: Information on the economic cost of chronic conditions is important for local public health departments to plan their prevention, treatment, and control efforts. While estimates of the cost of chronic conditions are available from the CDC at the state level, adapting county-level estimates requires controlling for regional differences in health services usage, cost of care, life expectancy, and rates of chronic conditions.
Research Objective: We report the results from a study funded by the California Department of Public Health to develop estimates of the cost of chronic conditions for counties in California.
Data Sets and Sources: The project uses data from a variety of sources: CDC Cost Calculator estimates for the cost of following conditions: arthritis, asthma, cancer, cardiovascular diseases (congestive heart failure, coronary heart disease, hypertension, stroke, and other cerebrovascular diseases), depression, and diabetes. Costs estimates by condition, age, ethnicity, and gender are combined with utility scores (from published literature), population estimates (census data), regional adjusters, and life expectancy. Regional adjusters incorporated health services usage (estimated from state hospital data and the California Health Information Survey data for differences in health services usage across counties) and prices (using Medicare's regional price adjuster).
Study Design/Analysis: We use a prevalence approach that i) identifies the number of people with chronic diseases in each county in California in a given year (2010); ii) estimates the health burden (lost QALYs) for each condition by age, gender, and ethnicity; iii) estimates the economic burden of chronic diseases in each county, and iv) reports both the individual and combined estimates of the cost of chronic conditions by county.
Principal Findings: The initial estimates suggest the overall cost of chronic conditions in California counties is $76.617 billion dollars. We report the estimates per county and identify relatively low and high cost counties.
Conclusions: The estimated cost of chronic conditions varies significantly across counties as a result of both differences in population, rates of conditions, and the regional adjusters.
Implications for Public Health Practice and Policy: These findings provide an indication to counties of both the current and future burden of chronic conditions.