Evidence map›Paper›PMID 30428401›Full record

ArticleSocial science & medicine (1982)2019

How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations.

K Hauck, A Morton, K Chalkidou, Y-Ling Chi, A Culyer, C Levin, R Meacock, M Over, R Thomas, A Vassall and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Social science & medicine (1982), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Article
  6. Review
  7. Article
  8. Article
  9. Review
  10. Review
  11. Article
  12. Review
  13. Article
  14. Article
  15. Article
  16. SEEP-CI: A Structured Economic Evaluation Process for Complex Health System Interventions.International journal of environmental research and public health · 2020
    Article
  17. Article
  18. Article
  19. Article
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

K HauckDepartment of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, London, W2 1PG, United Kingdom. Electronic address: k.hauck@imperial.ac.uk.
A MortonDepartment of Management Science, Strathclyde Business School, University of Strathclyde, 199 Cathedral Street, Glasgow, G4 0QU, United Kingdom. Electronic address: alec.morton@strath.ac.uk.
K ChalkidouCenter for Global Development, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, London, W2 1PG, United Kingdom. Electronic address: kchalkidou@cgdev.org.
Y-Ling ChiGlobal Health and Development Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, London, W2 1PG, United Kingdom. Electronic address: y.chi@imperial.ac.uk.
A CulyerDepartment of Economics and Related Studies, University of York, Heslington, York, YO10 5DD, United Kingdom. Electronic address: tony.culyer@york.ac.uk.
C LevinDepartment of Global Health, University of Washington, NJB Box #359931, 325 Ninths Avenue, Seattle, WA, 98104, USA. Electronic address: clevin@uw.edu.
R MeacockCentre for Primary Care, The University of Manchester, 4.311 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, United Kingdom. Electronic address: rachel.meacock@manchester.ac.uk.
M OverCenter for Global Development, 2055 L Street NW, Fifth Floor, Washington, DC, 20036, USA. Electronic address: mover@cgdev.org.
R ThomasDepartment of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom. Electronic address: r.a.thomas@lse.ac.uk.
A VassallDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom. Electronic address: Anna.Vassall@lshtm.ac.uk.
S VerguetDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA. Electronic address: verguet@hsph.harvard.edu.
P C SmithImperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom. Electronic address: peter.smith@imperial.ac.uk.

Funding

Medical Research Council MR/K010174/1BMedical Research Council MR/R015600/1
6 · The paper itself

Abstract

Health interventions often depend on a complex system of human and capital infrastructure that is shared with other interventions, in the form of service delivery platforms, such as healthcare facilities, hospitals, or community services. Most forms of health system strengthening seek to improve the efficiency or effectiveness of such delivery platforms. This paper presents a typology of ways in which health system strengthening can improve the economic efficiency of health services. Three types of health system strengthening are identified and modelled: (1) investment in the efficiency of an existing shared platform that generates positive benefits across a range of existing interventions; (2) relaxing a capacity constraint of an existing shared platform that inhibits the optimization of existing interventions; (3) providing an entirely new shared platform that supports a number of existing or new interventions. Theoretical models are illustrated with examples, and illustrate the importance of considering the portfolio of interventions using a platform, and not just piecemeal individual analysis of those interventions. They show how it is possible to extend principles of conventional cost-effectiveness analysis to identify an optimal balance between investing in health system strengthening and expenditure on specific interventions. The models developed in this paper provide a conceptual framework for evaluating the cost-effectiveness of investments in strengthening healthcare systems and, more broadly, shed light on the role that platforms play in promoting the cost-effectiveness of different interventions.

Indexed as

Cost-Benefit AnalysisDelivery of Health CareGovernment ProgramsHumansModels, TheoreticalConstraintsCost-effectiveness analysisEconomies of scopeHealthcare delivery platformsHealth system strengtheningHorizontal health care programsIntegrated service deliverySpillover effects

Identifiers

PMID30428401
PMCPMC6323413

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.