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Increasingly attention is shifting towards delivering essential packages of care, often based on clinical practice guidelines, as a means to improve maternal, child and newborn survival in low-income settings. Cost effectiveness analysis (CEA), allied to the evaluation of less complex intervention, has become an increasingly important tool for priority setting. Arguably such analyses should be extended to inform decisions around the deployment of more complex interventions. In the discussion, we illustrate some of the challenges facing the extension of CEA to this area. We suggest that there are both practical and methodological challenges to overcome when conducting economic evaluation for packages of care interventions that incorporate clinical guidelines. Some might be overcome by developing specific guidance on approaches, for example clarity in identifying relevant costs. Some require consensus on methods. The greatest challenge, however, lies in how to incorporate, as measures of effectiveness, process measures of service quality. Questions on which measures to use, how multiple measures might be combined, how improvements in one area might be compared with those in another and what value is associated with improvement in health worker practices are yet to be answered.

Original publication

DOI

10.1111/j.1365-3156.2010.02637.x

Type

Journal article

Journal

Trop Med Int Health

Publication Date

01/2011

Volume

16

Pages

97 - 104

Keywords

Child, Child Health Services, Child, Preschool, Cost-Benefit Analysis, Delivery of Health Care, Evidence-Based Medicine, Female, Health Services Research, Health Status Indicators, Humans, Infant, Infant, Newborn, Maternal Health Services, Practice Guidelines as Topic