Cost-Effectiveness Analysis

This special issue of the Journal of Health Communication: International Perspectives (Vol. 11, Supplement 2) examines the current challenges addressing cost-effectiveness in the context of health communication - specifically, in behaviour change communication (BCC) programmes. It is based on the premise that analysis of cost effectiveness can help determine which programmes deliver the "best" outcome (e.g., the greatest behaviour change) for the cost by answering questions like, "Can we alter the mix of our different communication sub-interventions to achieve greater gains?" or "Can we demonstrate that health communication interventions are a 'bargain' relative to other alternatives?" The intention is to explore the analytic techniques needed to measure the cost-effectiveness of comprehensive programmes - with multiple, mutually reinforcing channels designed to reach all segments of the population, as illustrated by applied communication examples from developing countries around the world.

As the authors in this special issue indicate, the challenge in evaluating the cost-effectiveness of these types of initiatives involves both obtaining appropriate estimates of costs, and measuring the effectiveness of the programme in bringing about the desired change. Here is a synopsis of each of the articles:

• "The Cost-Effectiveness of Health Communication Programs: What Do We Know?" - Paul Hutchinson and Jennifer Wheeler review the existing literature on the cost-effectiveness of communication programmes to produce health outcomes, both in developed and developing countries. The authors identify 45 studies that meet their criteria for rigour and relevant health outcomes. They also outline the methodological approaches used to date in arriving at these results. They conclude with an appeal for more systematic attention to the measurement of costs in future studies on this subject.
• "Cost-Effectiveness Analysis for Health Communication Programs" - David K. Guilkey, Paul Hutchinson, and Peter Lance provide an overview of the methodological challenges associated with calculating the effectiveness and cost-effectiveness of communication programmes. They identify problems inherent in this type of evaluation - such as controlling for nonrandom exposure, national and subnational programme designs, and focusing of interventions - and they provide guidance in addressing them.
• "Multivariate Causal Attribution and Cost-Effectiveness of a National Mass Media Campaign in the Philippines" - D. Lawrence Kincaid and Mai Phuong Do address the question of cost per new acceptor of family planning and increase in contraceptive prevalence in the Philippines, attributable to a nationally televised programme consisting of 4 spots. In addition to giving an in-depth discussion of methods, the authors also emphasise the role of theory in the design and evaluation of programmes.
• "Measuring the Cost-Effectiveness of a National Health Communication Program in Rural Bangladesh" - The authors (Paul Hutchinson, Peter Lance, David K. Guilkey, Mohammad Shahjahan, and Shahida Haque) offer a cost-effectiveness analysis of the Smiling Sun campaign in Bangladesh, designed to bring about changes in the use of health services for improved maternal and child health through health communication around antenatal visits and childhood immunisations. This article evaluates both the national-level campaign and local promotional activities.
• "Cost-Effectiveness of Environmental-Structural Communication Interventions for HIV Prevention in the Female Sex Industry in the Dominican Republic" - The authors (Michael Sweat, Deanna Kerrigan, Luis Moreno, Santo Rosario, Bayardo Gomez, Hector Jerez, Ellen Weiss, and Clare Barrington) determine the cost-effectiveness of 2 approaches to averting HIV infections among commercial sex workers in the Dominican Republic, one employing an environmental approach, and one combining the environmental approach with a structural approach. This article uses an outcome measure that is designed to be compared readily across different types of interventions: disability adjusted life years (DALYs).
• "Comparative Cost-Effectiveness of the Components of a Behavior Change Communication Campaign on HIV/AIDS in North India" - Suruchi Sood and Devaki Nambiar evaluate a mass media campaign on HIV prevention in India, focusing on the relative impact and cost-effectiveness of 3 different components: a television drama, a reality show for youth, and TV spots. Their analysis also examines factors that mediate behaviour change in different components of the campaign.
• "Cost-effectiveness Studies of Behavior Change Communication Campaigns: Assessing the State of the Science and How to Move the Field Forward" - Kevin D. Frick provides a commentary that situates this set of articles in the larger context of cost-effectiveness analysis in other areas of public health and health care utilisation. He specifically discusses the role of cost-outcome analysis in the decision-making process for resource allocation.

This special issue is intended for 2 main audiences: health communication specialists interested in designing the most effective programmes on limited budgets, and researchers/evaluators interested in applying state-of-the-art methods for conducting cost-effectiveness analysis of BCC programmes.

Click here to access the Editorial and Introduction online or in PDF format, and to read abstracts of each article.

For more information, contact:
Wendy Meltzer
Journal of Health Communication
iphwxm@gwumc.edu