05/06/2010

EvaluasiEkonomiProgram
Kesehatan
AriProbandari

Bacaan
WitterS.,EnsorT.,JowettM.andThompson
R 2000 Health Economics for Developing
R.,2000.HealthEconomicsforDeveloping
Countries:APracticalGuide.MacMilan
Publisher.England
DrummondM.,OBrienB.,Stoddart G.L.,
TorranceG.W.1997.Methodsforthe
Economic Evaluation of Health Care
EconomicEvaluationofHealthCare
Programmes,2nd,OxfordMedicalPublication,
NewYork

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DefinisiEvaluasiEkonomi(penuh)

The
Thecomparativeanalysis
comparative analysis ofalternatives
of alternatives
coursesofactionintermsofbothcostand
consequences

(Witteretal.2000)

ConsequencesA
Programme
CostA A

Choice

ComparatorB
CostB

ConsequencesB

(Drummondetal.1997)
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Partialvs FullEconomicEvaluation

Arebothcosts(inputs)andconsequences(outputs)ofthealternativesexamined?

no yes
Examines only Examines
Isthere consequences only cost
comparison
no PARTIALEVALUATION
PARTIALEVALUATION
oftwoor
more Outcome Cost
alternatives? description description Cost-outcome description

PARTIALEVALUATION FULLECONOMICEVALUATION

Cost minimization analysis

yes Efficacy or Cost effectiveness analysis
effectiveness Cost utility analysis
evaluation Cost Analysis Cost benefit analysis
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Mengapaevaluasiekonomidiperlukan?

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Sumber
Keputusan
daya Prioritas
rasional
terbatas

Perhitunganbiaya[1]
BiayaTidak
Langsung
Langsung
(opportunity
cost)
Biaya Biaya
Langsung Intangible

Biaya

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Fi d
Fixedcost
t

Overhead Variable
cost cost

Direct
i
Cost
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PerspektifPerhitunganBiaya

Masyarakat?
Provider?

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BiayaUPK
Sensitizationandmappingof DOT
providers Hospitalization
Training Othervisitsforpatient
Oh ii f i
Routineinteraction monitoring
with/supervisionofproviders Defaultertracing
Drugs Healtheducationforpatients
Sputumsmearsforscreeningand Recordingandreporting
diagnosis ProgrammeManagement
Sputumsmearsformonitoring Wasor
Xrays Beyondprojectexpenditure
Otherdiagnostictests
Oth di ti t t Coordinationmeetings
RoutineinteractionwithPRM NTPandKNCVStaff
healthcentre involvement
Visitsbydetailers/TB
programmerstoPPs

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Biayapasiendanpendamping
Biaya pasien Biaya pendamping
Transportations Transportation
Consultations(outpatient)
C l i ( i ) Timetakentoaccompany
Ti k
Hospitalization patient
Investigations(laboratory,X Wageslost
ray,othere.g.MRI) Dayslostfromstudies(e.g.
Drugs school/college)
Timetakentoaccesstreatment Other
Wageslostbypatient
Dayslostfromworkbypatient
Dayslostfromstudies(e.g.
school/college)bypatient
Interestpaidonloans
Others

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CaraMemperolehDataBiaya
Prospektif(evaluasiekonomi
d
dirancangberbarengandengan
b b d
suatupenelitian
klinik/epidemiologi)

Retrospektif(dataprimerdan
sekunder) mis laporan
sekunder),mis.laporan
keuanganprogram,wawancara
denganpetugas,observasi,
surveidengankuesioner.

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PerhitunganBiaya
Idealnya:ingredientapproach
Biayatotal=HargaXVolume

Namun,seringkalidatatidakmendukung
sehinggabiayatotal=biayaagregatsehingga
diperlukan asumsi untuk merinci
diperlukanasumsiuntukmerinci

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AspekyangDiperhatikandalam
PerhitunganBiaya
Discountrate
Depresiasi
Lifetime

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DiscountRate
Theprocessofconvertingsumstobe
receivedatafuturedatetoapresentvalue.
i d t f t d t t t l
Theinterestratewhichisusediscalledthe
discountrate.Itshouldbebasedonthesocial
timepreferenceratewhichappliesinthat
group.
Konvensi:3%5%

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HubunganDiscountRatedanInflation
Rate
Angkadiscountratebisalebihrendahdari
inflasi
Discountratedapatdiperhitungkandengan
menimbangbesarnyaangkainflasi
Contoh:angkainflasiumumnya8%,diprediksi
akanmeningkatmenjadi10%,discountrate
( iil) 4%
(riil)4%,makabesarnyadiscountratesetelah
k b di t t t l h
mempertimbangkaninflasiadalah:
r=1.04X[1.08/1.10)
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Depreciation
Thechangeinthevalueofagoodovertime,
d t it d t i ti
duetoitsdeterioratingphysicalstateorit
h i l t t it
beingsupersededbynewtechnology.
Berlakuuntukbiayakapital(modal),seperti
peralatan

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Efektifitas
Theextenttowhichaspecificintervention,
procedure regimen or service when deployed
procedure,regimenorservice,whendeployed
inthefield,doeswhatitisintendedtodofor
adefinedpopulation

Contoh:
EfektifitasprogramTBadalahjumlahkasusTB
BTApositifyangsembuhdanlengkap
pengobatan
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Type of study Cost Identification of consequences

consequences
Cost Dollars Identical None
minimization
analysis
Cost Dollars Single outcome, common Natural units (e.g. life
effectiveness
ff ti t both
to b th alternatives,
lt ti b
butt years gained,
i d didisability-
bilit
analysis achieved in different days saved, points of
degrees blood pressure reduction,
etc)
Cost utility Dollars Single or multiple DALY or QALY
analysis outcome, not necessary
common to both
alternative
Cost Benefit Dollars Single or multiple Dollars
Analysis outcome, not necessary
common to both
alternative

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CostEffectivenessAnalysis(CEA)
Evaluasi ekonomi antar beberapa alternatif
dengan tingkat konsekuensi/efektifitas yang
yang
berbeda tetapi dapat dibandingkan dengan
satu ukuran keluaran.
Perbandingan dinyatakan dalam rasio biaya
efektifitas (costeffectivenessratio).

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UkuranEfektifitasdalamCEA
Ukurankuantitas
Contoh:
1.Jumlah kasus tambahan yg terdeteksi dan
berhasil disembuhkan melalui implementasi
PPMDOTSdi RSdan PS
2 Penurunan keterlambatan diagnosisdan
2.Penurunan diagnosis dan
pengobatan melalui PPMDOTS

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Contoh:CostEffectivenessRatio
Spraying breeding Impregnated
sites
it b d t
bednets
1. Annual program 10 000 US dollar 4 000 US dollar
cost

..
6. Death averted 64 34
7 Cost per death
7.Cost 156 US dollar 118 US dollar
averted (no.1 dibagi
no.6)

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CostUtilityAnalysis
Ukuran effectivenessantara satu program
d
dengan programyanglainmungkin
l i ki berbeda.
b b d
Dalam satu programmungkin ada lebih dari 1
outcome (ukurankuantitasdankualitas
hidup).
Contoh:cost
Contoh : cost perQALY(qualityadjustedlife
per QALY (quality adjusted life
years)atau costperDALY(disabilityadjusted
lifeyears)

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Utility
Istilahekonomiuntukmenggambarkan
t t
tentangwelfareyangdidapatkanoleh
lf did tk l h
seseorangkarenamengkonsumsisuatuhal.
Menunjukkanaspekkepuasan/kualitas
hidup.

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QualityAdjustedLifeYear(QALY)
Ameasureofhealthgainwhichaimsto
measurelifeyearsaddedbuatalsothequality
lif dd d b t l th lit
oflifewhichisachievedinthoseyears

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Disabilityadjustedlifeyear
Ameasureoftheburdenofdisease:
prematuredeathanddisability.
t d th d di bilit

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PengambilanKeputusanBerdasarkan
HasilCERatio/CURatio?
Independence Program MutuallyExclusive Program
UrutanCERatiodaripalingkecil
U t CE R ti d i li k il C t h U t CE R ti d i li
ContohUrutanCERatiodaripaling
sampaibesar(per100orang): kecilsampaibesar(per100orang),:
1. 5 1. 5
2. 10 2. 10
3. 20 3. 20
4. 25 4. 25
5. 40 5. 40

Jikadanayangtersediaadalah50 Jikadanayangtersediaadalah50
makayangprogramyangdipilih makaprogramyangdipilihadalah
adalah1(300pasien)+2(200pasien) program1untuk1000orang

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CostMinimizationAnalysis
Membandingkan 2atau lebih pilihan dengan
tingkat effectivenessyangsama,untuk
effectiveness yang sama, untuk
mencari mana yangmembutuhkan paling
sedikit resources.
Bentuk khusus dari CEA/CUA

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CostBenefitAnalysis

Cost Benefit

NETSOCIALBENEFIT 30

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CostBenefitAnalysis
Digunakanuntukmengukur/prediksi
k
kemanfaatansuatuprogramdalamjangka
f t t d l j k
panjangdibandingbiayanya.
Mengukurtingkatpenghargaanpengguna
terhadapsuatuprogramkesehatan.
Dipakaiuntuksurveipasar.
Dipakai untuk survei pasar

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Metodeuntukmengukurbenefitdalamnilaiuang
Whose How it is elicited Example
judgement?
Policy-makers/public Explicit/stated preference e.g. court orders: how much is paid in
figures compensation for injuries

Implicit in e.g. legislation on road safety: how much is

decisions/revealed spent on it
preference

Individuals Direct Willingness to pay (WTP)

(patients or survey/stated surveys, e.g. contingent
general public) preference valuation: how much would
you pay to avoid X condition?
e g conjoint
e.g. conjoint analysis:
analysis : ranking
scenarios with different
attributes to ascertain
preference and WTP
Implicit in e.g. wage premia for risky job, or life insurance
behaviour/revealed payments
preference
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DariManaKitaDapatkanData
Efektifitas?
Menghitung(daripenelitian)
Literaturreview(metaanalisis)

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UncertainityAnalysis
Ketidakpastiandalambiayamaupun
efektivitas
f kti it
Rentangnilai(range):biayamaupun
efektivitas
Diperolehdengananalisisstatistikterhadao
data biaya dan efektifitas
databiayadanefektifitas

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SensitivityAnalysis
Mengujiapakahsuatuhasilakanberubahjika
variabelkunciberubah.Variabelyangdipakai
i b lk ib b h V i b l di k i
dalamanalisissensitivitasadalahvariabel
yangrentangnilainyacukupbesar(diketahui
darihasiluncertaintyanalysis

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ContohPertanyaanEvaluasiEkonomi
Apakahoutputtersebutsebandingdengan
bi
biayayangdikeluarkandibandingkanjikakita
dik l k dib di k jik kit
tidakmelakukanprogramAtsb?

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Jikakitainginmemperluassuatuprogram,
apakahbiayayangakankitakeluarkan
k h bi k kit k l k
sebandingdengantambahanefektifitas
programyangakankitadapatkan?

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