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Purpose: Provision of primary care services for older women in resource-poor settings is a public health priority. Motivated by the momentum of the impending widespread introduction of single lifetime cervical cancer screening in poor countries, we sought to identify potential interventions that might be included in a package of personal health services targeted to women during this single health care visit between the ages of 35 and 45.
Methods: We developed an integer programming (IP) model to maximize disability-adjusted life-years (DALYs) averted from health interventions, subject to budget and human resource constraints in four resource-poor regions. In addition to cervical cancer, interventions for six other diseases were considered: breast cancer, colorectal cancer, cardiovascular disease, depression, iron deficiency, and sexually-transmitted diseases. Inputs to the IP model were calculated using Markov models, which estimated DALYs averted and costs per woman for each intervention. Human resource constraints were expressed as limits to available staff-time (distinguishing clinic and laboratory personnel) for each intervention. Data were obtained from regional reports and surveys published by the World Health Organization, international databases, the published literature, and expert opinion.
Results: If only a budget constraint ($100/woman) is applied, most of the programs would be funded in all regions at a total cost of $41 to $99 per woman, and total benefits of 0.1369 to 0.2613 DALYs averted per woman. With the addition of a staff-time constraint equal to one-half of what is required to implement all interventions, the more staff-intensive interventions, such as screening for breast and colorectal cancer, would be excluded from the package. A more typical scenario in poor countries is that technical laboratory staff is more scarce than clinic staff; we therefore examined a scenario that included the budget constraint and limits of 75% of the clinic staff-time, but only 25% of the lab staff-time. For this analysis, only interventions for cervical cancer, depression, and iron deficiency were included as part of the package.
Conclusions: While only focusing on a select group of diseases and interventions, this analysis demonstrates the advantages of broadening one’s analytic scope from assessing costs and benefits associated with a single disease-intervention pair, to using methods of decision sciences to design a package of services for multiple diseases, explicitly taking into account several real-world constraints.
See more of Oral Concurrent Session B - Public Health 2
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)